ArticleDiabetes therapy : research, treatment and education of diabetes and related disorders2018
Utility and Limitations of Glycated Hemoglobin (HbA1c) in Patients with Liver Cirrhosis as Compared with Oral Glucose Tolerance Test for Diagnosis of Diabetes.
Article in Diabetes therapy : research, treatment and education of diabetes and related disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 34 citations in OpenAlex.
- An Open-Label, Dose-Escalation Study to Assess the Safety and Efficacy of IL-22 Agonist F-652 in Patients With Alcohol-associated Hepatitis.Hepatology (Baltimore, Md.) · 2020Trial
- Editorial: Diabetes Management in Cirrhosis-The Window of Opportunity Before Decompensation.Alimentary pharmacology & therapeutics · 2026Article
- High hepatic insulin resistance is linked to glucose and lipid profiles in Korean adults with type 2 diabetes.Frontiers in endocrinology · 2026Article
- Critical Relationship Between Iron Deficiency Anaemia (IDA) and Glycated Haemoglobin (HbA1c): An Updated Review.Mini reviews in medicinal chemistry · 2026Review
- Hemoglobin glycation index can be used as a predictor of diabetes mellitus and prediabetes: a cohort study.BMC endocrine disorders · 2025Article
- Oxidative and Glycation Stress Biomarkers: Advances in Detection Technologies and Point-of-Care Clinical Applications.Molecules (Basel, Switzerland) · 2025Review
- Correlation of Serum Zinc Levels with Hepatic Encephalopathy Severity in Patients with Decompensated Liver Cirrhosis: A Prospective Observational Study from Egypt.Biological trace element research · 2025Observational
- Pancreatic extracellular volume fraction based on dual-energy computed tomography iodine maps: association with diabetes.Quantitative imaging in medicine and surgery · 2025Article
- Article
- Microfluidic-based systems for the management of diabetes.Drug delivery and translational research · 2024Review
- An incidental finding of a hemoglobin E variant in a diabetic patient with an abnormal glycated hemoglobin level: a case report.Journal of medical case reports · 2024Article
- Hepatic and pancreatic extracellular volume fraction analysis using contrast-enhanced CT in patients with diabetes mellitus and pre-diabetes.Japanese journal of radiology · 2024Article
- Integrated modeling of labile and glycated hemoglobin with glucose for enhanced diabetes detection and short-term monitoring.iScience · 2024Article
- Impact of Hyperglycemia on Complication and Mortality after Transarterial Chemoembolization for Hepatocellular Carcinoma.Diabetes & metabolism journal · 2024Article
- Optimal glycated hemoglobin A1c value for prediabetes and diabetes in patients with pancreatic diseases.Frontiers in endocrinology · 2023Article
- Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.World journal of gastroenterology · 2022Review
- Association of Protein Z with Prediabetes and Type 2 Diabetes.Endocrinology and metabolism (Seoul, Korea) · 2021Article
- Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes.Journal of clinical medicine · 2021Review
- Limited Agreement between Classifications of Diabetes and Prediabetes Resulting from the OGTT, Hemoglobin A1c, and Fasting Glucose Tests in 7412 U.S. Adults.Journal of clinical medicine · 2020Article
- Increased Levels of Glycated Hemoglobin A1c and Iron Deficiency Anemia: A Review.Medical science monitor : international medical journal of experimental and clinical research · 2019Review
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
introductionTo study the utility of glycated hemoglobin (HbA1c) in the diagnosis of diabetes in patients with cirrhosis as compared to the gold standard oral glucose tolerance test (OGTT) and to see the effect of anemia and severity of cirrhosis on its performance.
methodsIndividuals (n = 100) with an established diagnosis of liver cirrhosis were recruited. The OGTT was performed as described by the World Health Organization (WHO). The severity of cirrhosis was calculated using the Child-Turcotte-Pugh (CTP) score. The severity of anemia was defined according to WHO criteria. The utility of HbA1c was compared against the OGTT results. Test sensitivity and specificity were used to describe the diagnostic accuracy of HbA1c.
resultsA total of 100 subjects aged 46.9 ± 9.1 years (mean ± standard deviation) participated in the study, of whom 65% were recruited from out patient department of our hospital. The overall sensitivity and specificity of a HbA1c level of ≥ 6.5% for the diagnosis of diabetes in patients with cirrhosis was 77.1% (95% CI 59.9, 89.6) and 90.8% (95% CI 81.0, 96.5), respectively. The positive and negative predictive values were 81.8% (95% CI 67.3, 90.8) and 88.1% (95% CI 80.0, 93.2), respectively. The area under the curve was 0.85 (95% CI 0.75-0.94). The sensitivity of HbA1c for diagnosing diabetes in outpatients was 87.0% (95% CI 66.4, 97.2) and was better than that for diagnosing diabetes in hospitalized patients (58.3%; 95% CI 27.7, 84.8). The sensitivity of HbA1c for diagnosing diabetes was poor in patients with moderate to severe anemia. The difference in sensitivity and specificity was not statistically different for CTP classes A, B and C. The prevalence of diabetes as defined by American Diabetes Association OGTT criteria was 35% (95% CI 25.7-45.2%).
conclusionsTaking OGTT as the gold standard, the sensitivity of HbA1c for diagnosing diabetes is good when used in outpatients with cirrhosis. However, the sensitivity of HbA1c decreases when it is used for hospitalized patients, suggesting that it is not a good test for diagnosis of diabetes in such cases. It also performs poorly if the patient has moderate to severe anemia.
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