ArticleJournal of general internal medicine2008
Value of risk stratification to increase the predictive validity of HbA1c in screening for undiagnosed diabetes in the US population.
Article in Journal of general internal medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 61 citations in OpenAlex.
- Guideline
- Stratified patient-centered care in type 2 diabetes: a cluster-randomized, controlled clinical trial of effectiveness and cost-effectiveness.Diabetes care · 2013Trial
- Hemoglobin A1c testing in an emergency department.Journal of diabetes science and technology · 2011Trial
- HbA1c and brain health across the entire glycaemic spectrum.Diabetes, obesity & metabolism · 2021Article
- Article
- OGTT 2-hour serum C-peptide index as a predictor of post-transplant diabetes mellitus in kidney transplant recipients.Annals of translational medicine · 2019Article
- Prevalence of pre-diabetes and type 2 diabetes mellitus among Sami and non-Sami men and women in Northern Norway - The SAMINOR 2 Clinical Survey.International journal of circumpolar health · 2018Article
- An investigation into the relationship between plain water intake and glycated Hb (HbA1c): a sex-stratified, cross-sectional analysis of the UK National Diet and Nutrition Survey (2008-2012).The British journal of nutrition · 2017Article
- Management of Hyperglycemia and Diabetes in the Emergency Department.Current diabetes reports · 2017Review
- New-onset diabetes and glucose regulation are significant determinants of left ventricular hypertrophy in renal transplant recipients.Journal of diabetes research · 2015Article
- Health literacy and blood glucose among Guyanese emergency department patients without diagnosed diabetes: a cross-sectional study.Diabetology & metabolic syndrome · 2015Article
- Point-of-Care HbA1c Testing with the A1cNow Test Kit in General Practice Dental Clinics: A Pilot Study Involving Its Accuracy and Practical Issues in Its Use.Point of care · 2014Article
- HbA1c for screening and diagnosis of diabetes mellitus.Endocrine · 2013Review
- Diabetes in the Emergency Department and Hospital: Acute Care of Diabetes Patients.Current emergency and hospital medicine reports · 2013Article
- Pre-transplant HbA1c level as an early marker for new-onset diabetes after renal transplantation.International urology and nephrology · 2013Article
- Hemoglobin A1c as a screen for previously undiagnosed prediabetes and diabetes in an acute-care setting.Diabetes care · 2011Article
- HbA(1c) values for defining diabetes and impaired fasting glucose in Asian Indians.Primary care diabetes · 2011Article
- Hemoglobin A1c as a predictor of incident diabetes.Diabetes care · 2011Article
- Article
- A1C for screening and diagnosis of type 2 diabetes in routine clinical practice.Diabetes care · 2010Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOpportunistic screening using hemoglobin A1c (HbA1c) may improve detection of undiagnosed diabetes but remains controversial.
objectiveTo evaluate the predictive validity of HbA1c as a screening test for undiagnosed diabetes in a risk-stratified sample of the US population.
designWeighted cross-sectional analysis of diabetes risk factors, HbA1c, and fasting plasma glucose (FPG) in National Health and Nutrition Examination Survey (NHANES), 1999-2004. SUBJECTS: Six thousand seven hundred and twenty-three NHANES participants from morning examination session, aged > or = 18 years and without prior physician-diagnosed diabetes. MEASUREMENTS: HbA1c and undiagnosed diabetes defined by FPG > or = 7.0 mmol/l (126 mg/dl).
resultsThe estimated prevalence of undiagnosed diabetes in the US population was 2.8% (5.5 million people). HbA1c had strong correlation with undiagnosed diabetes, with an area under the receiver-operating characteristic curve of 0.93. Independent predictors of undiagnosed diabetes were older age, male sex, black race, hypertension, elevated waist circumference, elevated triglycerides, and low high-density lipoprotein cholesterol. We derived a risk score for undiagnosed diabetes and stratified participants into low (0.44% prevalence), moderate (4.1% prevalence), and high (11.1% prevalence) risk subgroups. In moderate and high risk groups, a threshold HbA1c value > or = 6.1% identified patients requiring confirmatory FPG; HbA1c < or = 5.4% identified patients for whom diabetes could be reliably excluded. Intermediate HbA1c (5.5-6.0%) may exclude diabetes in moderate, but not high risk groups).
conclusionsRisk stratification improves the predictive validity of HbA1c in screening for undiagnosed diabetes in the US population. Although opportunistic screening with HbA1c would improve detection of undiagnosed diabetes, cost-effectiveness studies are needed before implementation of specific screening strategies using HbA1c.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.