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Bae, Rhee, Choi, Kim, Kim, Yoo, Park, Park, Lee, Oh, Park, and Kim: The Cutoff Value of HbA1c in Predicting Diabetes in Korean Adults in a University Hospital in Seoul
Original Article
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(6): 503-510.

Published online: 31 December 2009

DOI: https://doi.org/10.4093/kdj.2009.33.6.503

The Cutoff Value of HbA1c in Predicting Diabetes in Korean Adults in a University Hospital in Seoul

Ji Cheol Bae, Eun Jung Rhee, Eun Suk Choi, Ji Hoon Kim, Won Jun Kim, Seung Hyun Yoo, Se Eun Park, Cheol Young Park, Won Young Lee, Ki Won Oh, Sung Woo Park, Sun Woo Kim

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (hongsiri@hanmail.net)

Received 7 July 2009       Accepted 3 November 2009

Copyright © 2009 Korean Diabetes Association

Abstract

Background

Glycated hemoglobin (HbA1c) levels represent a 2~3 month average of blood glucose concentration. The use of HbA1c as a diagnostic tool for diabetes is gaining interest. Therefore, we determined the cutoff point of HbA1c for predicting abnormal glucose tolerance status in non-diabetic Korean subjects.

Methods

We analyzed the data from 1,482 subjects without diabetes mellitus in whom a 75-g oral glucose tolerance test (OGTT) was performed due to suspected abnormal glucose tolerance. We obtained an HbA1c cutoff point for predicting diabetes using Receiver Operating Characteristic (ROC) curve analysis.

Results

A cut-off point of 5.95% HbA1c yielded sensitivity of 60.8% and specificity of 85.6%, respectively, for predicting diabetes. There was a difference in HbA1c cut-off value between men and women, 5.85% and 6.05%, respectively.

Conclusion

To use the cut-off point of 5.95% HbA1c for predicting undiagnosed diabetes in Koreans may be reliable. However, studies of different ethnic groups have reported disparate HbA1c cut-off points. Thus, ethnicity, age, gender, and population prevalence of diabetes are important factors to consider in using elevated HbA1c value as a tool to diagnose diabetes.

Keywords: Diabetes mellitus, Diagnosis, Glycated hemoglobin A1c

Figures and Tables

Fig. 1
Receiver operating characteristic curves for HbA1c corresponding undiagnosed diabetes defined by ADA criteria.
kdj-33-503-g001
Table 1
Clinical characteristics of the subjects
kdj-33-503-i001

Data are expressed as mean ± SD, or no. (%). BMI, body mass index; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; OGTT, oral glucose tolerance test.

Table 2
Distribution of subjects according to glucose tolerance status groups and gender groups
kdj-33-503-i002

P = 0.001 in Chi-square test performed to compare the proportion of the subjects between each group. combined, IFG and IGT; I-IFG, isolated impaired fasting glucose; I-IGT, isolated impaired glucose tolerance.

Table 3
Comparisons of mean value for HbA1c in groups divided by glucose metabolism in different gender groups
kdj-33-503-i003

*P < 0.05 in post-hoc analyses with combined and diabetes groups except for female groups (significant differences only with diabetes group), †P < 0.05 in post-hoc analyses with all other groups, ‡Statistical significances were tested by one-way ANOVA test. As a post hoc analysis, Tukey's multiple comparison is performed. combined, IFG and IGT; HbA1c, glycated hemoglobin; I-IFG, isolated impaired fasting glucose; I-IGT, isolated impaired glucose tolerance.

Table 4
Comparison of sensitivity and specificity for predicting diabetes based on fasting glucose and 2 hour oral glucose tolerance test, at various levels of HbA1c
kdj-33-503-i004

AUC, area under the curve; HbA1c, glycated hemoglobin.

Table 5
Comparison of sensitivity and specificity for predicting diabetes based on fasting glucose and 2 hour oral glucose tolerance test, at various levels of HbA1c according to obesity categorized by body mass index ≥ 25 kg/m2
kdj-33-503-i005

AUC, area under the curve; BMI, body mass index; HbA1c, glycated hemoglobin.

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