Hemoglobin A1c As a Screen for Previously Undiagnosed Prediabetes and Diabetes in an Acute-Care Setting Full Text
Diabetes Care, 07/22/2011
Silverman RA et al. – The authors identified HbA1c cut points to screen for prediabetes and diabetes in an emergency–department adult population. The values coincide with published outpatient study findings and suggest that an emergency–department visit provides an opportunity for HbA1c–based dysglycemia screening.
Methods- This was a prospective observational study of adults aged ≥18 years with no known history of hyperglycemia presenting to an emergency department with acute illness.
- Outpatient FBS and 2–h OGTT were performed after recovery from the acute illness, resulting in diagnostic categorizations of prediabetes, diabetes, and dysglycemia (prediabetes or diabetes).
- Optimal cutoffs were determined and performance data identified for cut points.
- A total of 618 patients were included, with a mean age of 49.7 (±14.9) years and mean HbA1c of 5.68% (±0.86).
- On the basis of an OGTT, the prevalence of previously undiagnosed prediabetes and diabetes was 31.9 and 10.5%, respectively.
- The optimal HbA1c–screening cutoff for prediabetes was 5.7% (area under the curve [AUC] = 0.659, sensitivity = 55%, and specificity = 71%), for dysglycemia 5.8% (AUC = 0.717, sensitivity = 57%, and specificity = 79%), and for diabetes 6.0% (AUC = 0.868, sensitivity = 77%, and specificity = 87%).
