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
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
收藏
页码:51 / 58
页数:8
相关论文
共 29 条
[21]   HbA1c in diagnosing and predicting Type 2 diabetes in impaired glucose tolerance: the Finnish Diabetes Prevention Study [J].
Pajunen, P. ;
Peltonen, M. ;
Eriksson, J. G. ;
Ilanne-Parikka, P. ;
Aunola, S. ;
Keinanen-Kiukaanniemi, S. ;
Uusitupa, M. ;
Tuomilehto, J. ;
Lindstrom, J. .
DIABETIC MEDICINE, 2011, 28 (01) :36-42
[22]   Variation at the Melanocortin 4 Receptor Gene and Response to Weight-Loss Interventions in the Diabetes Prevention Program [J].
Pan, Qing ;
Delahanty, Linda M. ;
Jablonski, Kathleen A. ;
Knowler, William C. ;
Kahn, Steven E. ;
Florez, Jose C. ;
Franks, Paul W. .
OBESITY, 2013, 21 (09) :E520-E526
[23]   Predictive value of HbA1c for incident diabetes among subjects with impaired glucose toleranceuanalysis of the Indian Diabetes Prevention Programmes [J].
Ramachandran, A. ;
Snehalatha, C. ;
Shetty, A. Samith ;
Nanditha, A. .
DIABETIC MEDICINE, 2012, 29 (01) :94-98
[24]   Lifestyle Modification and Prevention of Type 2 Diabetes in Overweight Japanese With Impaired Fasting Glucose Levels A Randomized Controlled Trial [J].
Saito, Toshikazu ;
Watanabe, Makoto ;
Nishida, Junko ;
Izumi, Tomono ;
Omura, Masao ;
Takagi, Toshikazu ;
Fukunaga, Ryuzo ;
Bandai, Yasutsugu ;
Tajima, Naoko ;
Nakamura, Yosikazu ;
Ito, Masaharu .
ARCHIVES OF INTERNAL MEDICINE, 2011, 171 (15) :1352-1360
[25]   Racial Differences in Glycemic Markers: A Cross-sectional Analysis of Community-Based Data [J].
Selvin, Elizabeth ;
Steffes, Michael W. ;
Ballantyne, Christie M. ;
Hoogeveen, Ron C. ;
Coresh, Josef ;
Brancati, Frederick L. .
ANNALS OF INTERNAL MEDICINE, 2011, 154 (05) :303-309
[26]   Glycated Hemoglobin and the Risk of Kidney Disease and Retinopathy in Adults With and Without Diabetes [J].
Selvin, Elizabeth ;
Ning, Yang ;
Steffes, Michael W. ;
Bash, Lori D. ;
Klein, Ronald ;
Wong, Tien Y. ;
Astor, Brad C. ;
Sharrett, A. Richey ;
Brancati, Frederick L. ;
Coresh, Josef .
DIABETES, 2011, 60 (01) :298-305
[27]   Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults. [J].
Selvin, Elizabeth ;
Steffes, Michael W. ;
Zhu, Hong ;
Matsushita, Kunihiro ;
Wagenknecht, Lynne ;
Pankow, James ;
Coresh, Josef ;
Brancati, Frederick L. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (09) :800-811
[28]   Longitudinal association of glucose metabolism with retinopathy - Results from the Australian Diabetes Obesity and Lifestyle (AusDiab) study [J].
Tapp, Robyn J. ;
Tikellis, Gabriella ;
Wong, Tien Y. ;
Harper, C. Alex ;
Zimmet, Paul Z. ;
Shaw, Jonathan E. .
DIABETES CARE, 2008, 31 (07) :1349-1354
[29]   Should the Hemoglobin A1c Diagnostic Cutoff Differ Between Blacks and Whites? A Cross-sectional Study [J].
Tsugawa, Yusuke ;
Mukamal, Kenneth J. ;
Davis, Roger B. ;
Taylor, William C. ;
Wee, Christina C. .
ANNALS OF INTERNAL MEDICINE, 2012, 157 (03) :153-+