Diagnosing prediabetes with a combination of glycated hemoglobin and impaired fasting glucose may be a more effective predictor of progression to diabetes than either test alone, Japanese researchers found.

Introduction of the new HbA1c criterion in addition to the assessment of fasting plasma glucose could efficiently target patients who are most likely to progress to diabetes and allow for early intervention,” they wrote.

Relying on HbA1c levels between 5.7% and 6.4% to diagnose prediabetes has been controversial, the researchers explained, as many patients who had been diagnosed on the basis of impaired fasting glucose are reclassified as not having the disorder.

That led some to suspect that screening by HbA1c alone may miss a large number of prediabetic patients.
During the study period, 338 patients developed diabetes, and a diagnosis of prediabetes preceded full disease in:

• 32% of those diagnosed by impaired fasting glucose alone
• 9% of those diagnosed by HbA1c alone
• 46% diagnosed by a combination of impaired fasting glucose and HbA1c

These findings show that the “predictive power achieved through use of the two criteria was multiplied rather than having an additive effect,” the researchers wrote.

“In those countries that could afford such tests, the use of blood glucose and HbA1c together … would identify many more at risk for diabetes, and even cardiovascular disease,” they wrote. “We believe it is better to cover a larger segment of people with preventive lifestyle advice to prevent future risk for diabetes, but this conclusion requires large-scale longitudinal studies.”

Ref: http://www.medpagetoday.com/MeetingCoverage/ADA/27273?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=333280