Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c: National Health and Nutrition Examination Survey 2005-2006

Ronald T. Ackermann, Yiling J. Cheng, David F. Williamson, Edward W. Gregg

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

Background: The American Diabetes Association (ADA) recently proposed the use of hemoglobin A1c as a practical and valid strategy to identify high-risk people for whom delivery of an intensive lifestyle intervention to prevent type 2 diabetes is likely to be cost effective. Purpose: To estimate composite risks of developing diabetes and cardiovascular disease (CVD) for adults with different hemoglobin A1c test results and to compare those risks with those of adults who met the 2003 ADA definition for prediabetes. Methods: Cross-sectional data from the 20052006 National Health and Nutrition Examination Survey were analyzed in 2009. The method of Stern and colleagues was used to estimate the 7.5-year probability of type 2 diabetes, and the Framingham General CVD Risk Engine was used to estimate the 10-year probability of CVD for adults with different A1c results. Sample weights were used to account for sampling probability and to adjust for noncoverage and nonresponse. Results: Among adults meeting the 2003 ADA definition for prediabetes, the probabilities for incident type 2 diabetes (over 7.5 years) and CVD (over 10 years) were 33.5% and 10.7%, respectively. Use of A1c alone, in the range of 5.5% to <6.5%, would identify a population with comparable risks for diabetes (32.4% [SE=1.2%]) and CVD (11.4% [SE=0.6%]). A slightly higher cutoff (<5.7%) would identify adults with risks of 41.3% (SE=1.5%) for diabetes and 13.3% (SE=0.8%) for CVDrisks that are comparable to people enrolled in the Diabetes Prevention Program. Conclusions: A1c-based testing in clinical settings should be considered as a means to identify greater numbers of adults at high risk of developing type 2 diabetes and CVD.

Original languageEnglish (US)
Pages (from-to)11-17
Number of pages7
JournalAmerican Journal of Preventive Medicine
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2011

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Fingerprint Dive into the research topics of 'Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c: National Health and Nutrition Examination Survey 2005-2006'. Together they form a unique fingerprint.

Cite this