Journal List > Korean Diabetes J > v.33(4) > 1002306

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Lee, Chang, Chung, Kim, Park, Moon, Lee, Yoon, Chun, Won, Cho, and Lee: The Combination of Fasting Plasma Glucose and Glycosylated Hemoglobin as a Predictor for Type 2 Diabetes in Korean Adults
Original Article
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(4): 306-314.

Published online: 31 August 2009

DOI: https://doi.org/10.4093/kdj.2009.33.4.306

The Combination of Fasting Plasma Glucose and Glycosylated Hemoglobin as a Predictor for Type 2 Diabetes in Korean Adults

Chan Hee Lee1, Woo Jin Chang1, Hyun Hee Chung1, Hyun Jung Kim1, Sang Hyun Park1, Jun Sung Moon1, Ji Eun Lee1, Ji Sung Yoon1, Kyung Ah Chun2, Kyu Chang Won1, Ihn Ho Cho2, Hyoung Woo Lee1

1Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

2Department of Nuclear Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

Corresponding author (helee@med.yu.ac.kr)

Received 1 July 2009       Accepted 11 August 2009

Copyright © 2009 Korean Diabetes Association

Abstract

Background

The oral glucose tolerance test (OGTT) for detection of diabetes is difficult to perform in clinical settings. The aim of this study is to evaluate the performance of a more practical detection test, combined fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), as a predictor of diabetes mellitus (DM) in a Korean sample.

Methods

We examined 2,045 (M = 1,276, mean age = 47.8 ± 9.0 yrs) medical check-up program participants between January 2002 to December 2003. FPG, HbA1c and a number of other biochemical tests were performed at baseline and four after years after initial screening. Patients who originally presented with diabetes were excluded. The characteristics of newly-diagnosed DM patients and non-diabetic patients were compared.

Results

The incidence of newly diagnosed diabetes was 1.6% (32/2,045) after four years of follow up. The subjects in the DM group were older, had higher levels of SBP, DBP, FPG, HbA1c, triglyceride, HDL cholesterol, GGT and LDH (P < 0.05). In multivariate logistic regression analysis, FPG (odds ratio [OR] 1.124) and HbA1c (OR 4.794) were significantly correlated with onset of diabetes (P < 0.05). The interaction parameter between FPG and HbA1c was more than 1.0, indicating that the two effects are synergistic. The predictive cut-off values of HbA1c and FPG were 5.35% (area under curve [AUC] = 0.944) and 102.5 mg/dL (AUC = 0.930), respectively.

Conclusion

The combination of HbA1c above 5.35% and FPG above 102.5 mg/dL predicted the onset of diabetes in a Korean sample. These results suggest that the combination of FPG and HbA1c may be useful for predicting progression to type 2 diabetes in east Asians.

Keywords: Blood glucose, Fasting, Glycosylated hemoglobin A, Type 2 diabetes mellitus

Figures and Tables

Fig. 1
ROC curves & cut off values of HbA1c & FPG. The predicting cut-off values of HbA1c and FPG are 5.35% (AUC = 0.94), 102.5 mg/dL (AUC = 0.93) respectively. FPG, fasting plasma glucose.
kdj-33-306-g001
Table 1
Baseline characteristics of study subjects
kdj-33-306-i001

The incidence of newly diagnosed diabetes was 1.6% (32/2045) after 4 years follow up. Values are mean ± SD. ALP, Alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BUN, blood urea nitrogen; DBP, diastolic blood pressure; FPG, fasting plasma glucose; GGT, gamma glutamyl transferase; HDL-C, high density lipoprotein cholesterol; LDH, lactate dehydrogenase; LDL-C, low density lipoprotein cholesterol; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride.

Table 2
Logistic regression analysis of risk factors of diabetes mellitus in all subjects
kdj-33-306-i002

DBP, diastolic blood pressure; FPG, fasting plasma glucose; GGT, gamma glutamyl transferase; HDL-C, high density lipoprotein cholesterol; LDH, lactate dehydrogenase; SBP, systolic blood pressure; TG, triglyceride.

Table 3
Incidence of diabetes mellitus according to cut off values of FPG & HbA1c
kdj-33-306-i003

FPG, fasting plasma glucose.

Table 4
Clinical characteristics of subjects with impaired fasting glucose at baseline
kdj-33-306-i004

Values are mean ± SD. BMI, body mass index; DBP, diastolic blood pressure; SBP, systolic blood pressure.

Table 5
Logistic regression analysis of risk factors of diabetes mellitus in subjects with impaired fasting glucose at baseline
kdj-33-306-i005

FPG, fasting plasma glucose; GGT, gamma glutamyl transferase; LDH, lactate dehydrogenase.

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