HbA1c5.7-6.4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan(TOPICS3)

Yoriko Heianza, Shigeko Hara, Yasuji Arase, Kazumi Saito, Kazuya Fujiwara, Hiroshi Tsuji, Satoru Kodama, Shiun Dong Hsieh, Yasumichi Mori, Hitoshi Shimano, Nobuhiro Yamada, Kinori Kosaka, Hirohito Sone.Lancet 2011; 378: 147-55

Jon Wilson2012 PharmD CandidateMercer University COPHS

Prediabetes ADA guidelines criterion...

1)Impaired Fasting Glucose of 5.6 - 6.9mmol/L

Or

2)HbA1c of 5.7-6.4%

Diabetes

ADA guidelines criterion…

1)Fasting plasma glucose of 7.0mmol/L or higher

Or

2)HbA1c of 6.5% or higher

Objective

Compare the prevalence of prediabetes when diagnosed by HbA1c5.7-6.4% or by impaired fasting glucose and assess differences in progression rate to diabetes between the two criteria.

Study

Longitudinal cohort study

Between 1997 and 2003

Toranomon Hospital in Tokyo, Japan

Look at annual examinations for government employees

Rate of progression to diabetes was assessed annually

Began with 32,057 patients, aged 24-87 years old

Inclusion/Exclusion

Inclusion Patients who had annual examinations

regularly for 4 or 5 years Exclusion

Patients who were diagnosed with diabetes at baseline

6241 patients were eligible for the 6241 patients were eligible for the studystudy

Subgroups

Patients divided into 4 subgroups on basis of baseline diagnosis1)Impaired fasting glucose alone2)HbA1c alone

3)Both IFG and HbA1c

4)Normoglycaemia

Prevalence of prediabetes

Results

338 incident cases of diabetes during mean 4.7 year follow up

1)IFG alone- 32%(n=108)

2)HbA1c alone- 9%(n=30)

3)Both- 46%(n=154)

Results

Patients progressing to diabetes after 5 years

1)IFG- 9%(108/1270 cases)

2)HbA1c alone-7%(30/412 cases)

3)Both-38%(154/410 cases)

Results

Statistics

Hazard Ratios compared with normoglycaemic individuals

1)IFG alone: 6.16(95%CI 4.33-8.77)

2)HbA1c alone: 6.00(95%CI 3.76-9.56)

3)Both: 31.9(95%CI 22.6-45.0)

Conclusion

Diagnosis of prediabetes by both HbA1c and impaired fasting glucose ADA criteria resulted in increased risk of progression to diabetes.

Comment

By determining the likelihood of a patient with prediabetes progressing to diabetes, one can provide early intervention such as lifestyle modifications for control and possibly prevention.