ArticleCirculation2022
Risk of Macrovascular and Microvascular Disease in Diabetes Diagnosed Using Oral Glucose Tolerance Test With and Without Confirmation by Hemoglobin A1c: The Whitehall II Cohort Study.
Article in Circulation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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18 citing papers in PubMed, 31 citations in OpenAlex.
- HbA1c-Based Metabolic Stratification: A Retrospective Study of Clinical and Biological Differences Across Normoglycemic, Prediabetic, and Diabetic Subjects.Diagnostics (Basel, Switzerland) · 2026Article
- Long-Term Health Outcomes in Individuals With Confirmed Versus Unconfirmed Undiagnosed Diabetes Based on Oral Glucose Tolerance Test: Findings From the Tehran Lipid and Glucose Study.Journal of diabetes research · 2026Article
- Associations of Different Definitions of Prediabetes and Diabetes with All-Cause and Cause-Specific Mortality: A Nationally Representative Cohort Study.Military Medical Research · 2026Article
- Validation of the Finnish Diabetes Risk Score (FINDRISC) in a Central-European Population for the Prediction of Cumulative Incidence of Type 2 Diabetes Over 8-Years-Follow-Up of the Budakalász Health Examination Survey (BHES).Diabetes/metabolism research and reviews · 2025Article
- Interplay of glycated hemoglobin and traditional risk factors for the risk of atherosclerotic cardiovascular disease and all-cause mortality in people without diabetes.Cardiovascular diabetology · 2025Observational
- Machine learning-based prediction of diabetic peripheral neuropathy: model development and clinical validation.Frontiers in endocrinology · 2025Article
- Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study.PLoS medicine · 2024Article
- Impact of systematic diabetes screening on peri-operative infections in patients undergoing cardiac surgery.Scientific reports · 2024Article
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- Unveiling the hidden risks: albumin-corrected anion gap as a superior marker for cardiovascular mortality in type 2 diabetes: insights from a nationally prospective cohort study.Frontiers in endocrinology · 2024Article
- Predictive power of glycated hemoglobin in detecting severity of coronary artery disease in non-diabetic patients: A cross-sectional study in southern Iran.ARYA atherosclerosis · 2024Article
- Intermediate Hyperglycemia Increases the Risk of All-Cause Mortality in Premature Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.Reviews in cardiovascular medicine · 2023Article
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- Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest.Cardiovascular diabetology · 2023Article
- Insulin resistance mediates obesity-related risk of cardiovascular disease: a prospective cohort study.Cardiovascular diabetology · 2022Article
- Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?Diabetes & vascular disease researchArticle
- Serum albumin-enhanced screening: A triage strategy and predictive model for OGTT in community-managed patients with coronary heart disease.Diabetes & vascular disease researchArticle
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7 authors at 5 institutions in 5 countries.
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Abstract
backgroundIt is unclear whether replacing oral glucose tolerance test (OGTT) with hemoglobin A1c (HbA1c) measurement for diagnosing diabetes is justified. We aimed to assess the proportion of OGTT-diagnosed diabetes cases that can be confirmed by HbA1c and to examine whether individuals with OGTT diagnosis but nondiagnostic HbA1c are at higher risk of macrovascular and microvascular disease.
methodsParticipants were 5773 men and women from the population-based Whitehall II prospective cohort study in the United Kingdom. New OGTT diabetes cases diagnosed in clinical examinations in 2002 to 2004 and 2007 to 2009 were assessed for HbA1c confirmation (≥6.5%) in these and subsequent clinical examinations in 2012 to 2013 and 2015 to 2016. All participants were followed up for major cardiovascular events through linkage to electronic health records until 2017 and for incident chronic kidney disease (estimated glomerular filtration rate <60 mL·min
resultsOf the 378 (59.3%) participants with OGTT-diagnosed diabetes, 224 were confirmed by HbA1c during 4.1 years (SD, 4.1 years) of follow-up. We recorded 942 cardiovascular events over 12.1 years. After adjustment for nonmodifiable risk factors and compared with the 4997 diabetes-free participants, 371 participants with new HbA1c-confirmed diabetes and 405 participants with preexisting diabetes had increased risk of cardiovascular disease (hazard ratio, 1.53 [95% CI, 1.12-2.10] and 1.85 [95% CI, 1.50-2.28], respectively). The corresponding hazard ratios in the analysis of incident chronic kidney disease (487 cases; follow-up, 6.6 years) were 1.69 (95% CI, 1.09-2.62) for 282 participants with new HbA1c-confirmed diabetes and 1.67 (95% CI, 1.22-2.28) for 276 participants with preexisting diabetes. In both analyses, OGTT cases with nondiagnostic HbA1c (n=149 and 107) had a risk (hazard ratio, 0.99-1.07) similar to that of the diabetes-free population.
conclusionsMore than 40% of OGTT-diagnosed diabetes cases were not confirmed by HbA1c during an extended follow-up. However, because these individuals have a risk of cardiovascular disease and chronic kidney disease similar to that of the diabetes-free population, replacement of OGTT with HbA1c-based diagnosis appears justified.
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