HbA1c as a Predictor of Diabetes and as an Outcome in the Diabetes Prevention Program: A Randomized Clinical Trial

被引：86

作者：

Knowler, William C. ^{[1
]}

Edelstein, Sharon L. ^{[2
]}

Goldberg, Ronald B. ^{[3
]}

Ackermann, Ronald T. ^{[4
]}

Crandall, Jill P. ^{[5
]}

Florez, Jose C. ^{[6
,7
]}

Fowler, Sarah E. ^{[2
]}

Herman, William H. ^{[8
]}

Horton, Edward S. ^{[7
,9
]}

Kahn, Steven E. ^{[10
,11
]}

Mather, Kieren J. ^{[12
]}

Nathan, David M. ^{[6
,7
]}

机构：

[1] NIDDK, Phoenix, AZ 85014 USA

[2] George Washington Univ, Ctr Biostat, Rockville, MD USA

[3] Univ Miami, Miami, FL USA

[4] Northwestern Univ, Chicago, IL 60611 USA

[5] Albert Einstein Coll Med, New York, NY USA

[6] Massachusetts Gen Hosp, Boston, MA 02114 USA

[7] Harvard Univ, Sch Med, Boston, MA USA

[8] Univ Michigan, Ann Arbor, MI 48109 USA

[9] Joslin Diabet Ctr, Boston, MA 02215 USA

[10] VA Puget Sound Hlth Care Syst, Seattle, WA USA

[11] Univ Washington, Seattle, WA 98195 USA

[12] Indiana Univ, Indianapolis, IN 46204 USA

来源：

DIABETES CARE | 2015年 / 38卷 / 01期

基金：

美国国家卫生研究院;

关键词：

IMPAIRED GLUCOSE-TOLERANCE; LIFE-STYLE INTERVENTION; GLYCATED HEMOGLOBIN; RETINOPATHY; RISK; ASSOCIATION; METFORMIN; CRITERIA; ADULTS; LOCI;

D O I：

10.2337/dc14-0886

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE Glycated hemoglobin (HbA(1c)), a standard measure of chronic glycemia for managing diabetes, has been proposed to diagnose diabetes and identify people at risk. The Diabetes Prevention Program (DPP) was a 3.2-year randomized clinical trial of preventing type 2 diabetes with a 10-year follow-up study, the DPP Outcomes Study (DPPOS). We evaluated baseline HbA(1c) as a predictor of diabetes and determined the effects of treatments on diabetes defined by an HbA(1c) >= 6.5% (48 mmol/mol). RESEARCH DESIGN AND METHODS We randomized 3,234 nondiabetic adults at high risk of diabetes to placebo, metformin, or intensive lifestyle intervention and followed them for the development of diabetes as diagnosed by fasting plasma glucose (FPG) and 2-h postload glucose (2hPG) concentrations (1997 American Diabetes Association [ADA] criteria). HbA(1c) was measured but not used for study eligibility or outcomes. We now evaluate treatment effects in the 2,765 participants who did not have diabetes at baseline according to FPG, 2hPG, or HbA(1c) (2010 ADA criteria). RESULTS Baseline HbA(1c) predicted incident diabetes in all treatment groups. Diabetes incidence defined by HbA(1c) >= 6.5% was reduced by 44% by metformin and 49% by lifestyle during the DPP and by 38% bymetformin and 29% by lifestyle throughout follow-up. Unlike the primary DPP and DPPOS findings based on glucose criteria, metformin and lifestyle were similarly effective in preventing diabetes defined by HbA(1c). CONCLUSIONS HbA(1c) predicted incident diabetes. In contrast to the superiority of the lifestyle intervention on glucose-defined diabetes, metformin and lifestyle interventions had similar effects in preventing HbA(1c)-defined diabetes. The long-term implications for other health outcomes remain to be determined.

引用

页码：51 / 58

页数：8

共 29 条

[1]

[Anonymous], 2010, DIABETES CARE, DOI DOI 10.2337/dc10-s062

[2] 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study [J].

Bray, G. A. ;

Chatellier, A. ;

Duncan, C. ;

Greenway, F. L. ;

Levy, E. ;

Ryan, D. H. ;

Polonsky, K. S. ;

Tobian, J. ;

Ehrmann, D. ;

Matulik, M. J. ;

Clark, B. ;

Czech, K. ;

DeSandre, C. ;

Hilbrich, R. ;

McNabb, W. ;

Semenske, A. R. ;

Goldstein, B. J. ;

Smith, K. A. ;

Wildman, W. ;

Pepe, C. ;

Goldberg, R. B. ;

Calles, J. ;

Ojito, J. ;

Castillo-Florez, S. ;

Florez, H. J. ;

Giannella, A. ;

Lara, O. ;

Veciana, B. ;

Haffner, S. M. ;

Montez, M. G. ;

Lorenzo, C. ;

Martinez, A. ;

Hamman, R. F. ;

Testaverde, L. ;

Bouffard, A. ;

Dabelea, D. ;

Jenkins, T. ;

Lenz, D. ;

Perreault, L. ;

Price, D. W. ;

Steinke, S. C. ;

Horton, E. S. ;

Poirier, C. S. ;

Swift, K. ;

Caballero, E. ;

Jackson, S. D. ;

Lambert, L. ;

Lawton, K. E. ;

Ledbury, S. ;

Kahn, S. E. .

LANCET, 2009, 374 (9702) :1677-1686

[3]

Bray GA, 1999, DIABETES CARE, V22, P623

[4] Glycemic Thresholds for Diabetes-Specific Retinopathy Implications for diagnostic criteria for diabetes [J].

Colagiuri, Stephen ;

Lee, Crystal M. Y. ;

Wong, Tien Y. ;

Balkau, Beverley ;

Shaw, Jonathan E. ;

Borch-Johnsen, Knut .

DIABETES CARE, 2011, 34 (01) :145-150

[5] Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the US Population in 1988-2006 [J].

Cowie, Catherine C. ;

Rust, Keith F. ;

Byrd-Holt, Danita D. ;

Gregg, Edward W. ;

Ford, Earl S. ;

Geiss, Linda S. ;

Bainbridge, Kathleen E. ;

Fradkin, Judith E. .

DIABETES CARE, 2010, 33 (03) :562-568

[6]

Crandall J, 2006, J GERONTOL A-BIOL, V61, P1075

[7] Assessing gene-treatment interactions at the FTO and INSIG2 loci on obesity-related traits in the Diabetes Prevention Program [J].

Franks, P. W. ;

Jablonski, K. A. ;

Delahanty, L. M. ;

McAteer, J. B. ;

Kahn, S. E. ;

Knowler, W. C. ;

Florez, J. C. .

DIABETOLOGIA, 2008, 51 (12) :2214-2223

[8]

Gavin JR, 1997, DIABETES CARE, V20, P1183

[9] Race-ethnic differences in the association of genetic loci with HbA1c levels and mortality in US adults: the third National Health and Nutrition Examination Survey (NHANES III) [J].

Grimsby, Jonna L. ;

Porneala, Bianca C. ;

Vassy, Jason L. ;

Yang, Quanhe ;

Florez, Jose C. ;

Dupuis, Josee ;

Liu, Tiebin ;

Yesupriya, Ajay ;

Chang, Man-Huei ;

Ned, Renee M. ;

Dowling, Nicole F. ;

Khoury, Muin J. ;

Meigs, James B. .

BMC MEDICAL GENETICS, 2012, 13

[10]

Haffner S, 2005, DIABETES, V54, pA1

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