A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors: The Insulin Resistance Atherosclerosis Study (IRAS)

Carlos Lorenzo, Lynne E. Wagenknecht, Anthony J G Hanley, Marian J. Rewers, Andrew J. Karter, Steven M. Haffner

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE - A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known. RESEARCH DESIGN AND METHODS - A 2-h glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained at the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study (IRAS). For this report, 385 individuals were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG). RESULTS - IFG and IGT identified 69.1 and 59.5% of all individuals at increased risk of diabetes, respectively. A1C 5.7-6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26; P > 0.01), acute insulin response (r = - 0.20 vs. - 0.09; P < 0.01), and waist circumference (r = 0.43 vs. 0.25; P < 0.001) by the Spearman correlation test. Similarly, 2-h plasma glucose was more strongly related to Si (r = - 0.40 vs. - 0.27; P < 0.01) and triglycerides (r = 0.30 vs. 0.08; P < 0.001). CONCLUSIONS - A1C 5.7-6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h plasma glucose seem to be more precise correlates of insulin resistance and secretion than A1C and, in general, better for other metabolic disorders.

Original languageEnglish (US)
Pages (from-to)2104-2109
Number of pages6
JournalDiabetes Care
Volume33
Issue number9
DOIs
StatePublished - Sep 2010

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Insulin Resistance
Atherosclerosis
Fasting
Glucose
Glucose Intolerance
Glucose Tolerance Test
Insulin
Waist Circumference
Hispanic Americans
varespladib methyl
African Americans
Triglycerides
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors : The Insulin Resistance Atherosclerosis Study (IRAS). / Lorenzo, Carlos; Wagenknecht, Lynne E.; Hanley, Anthony J G; Rewers, Marian J.; Karter, Andrew J.; Haffner, Steven M.

In: Diabetes Care, Vol. 33, No. 9, 09.2010, p. 2104-2109.

Research output: Contribution to journalArticle

Lorenzo, Carlos ; Wagenknecht, Lynne E. ; Hanley, Anthony J G ; Rewers, Marian J. ; Karter, Andrew J. ; Haffner, Steven M. / A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors : The Insulin Resistance Atherosclerosis Study (IRAS). In: Diabetes Care. 2010 ; Vol. 33, No. 9. pp. 2104-2109.
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abstract = "OBJECTIVE - A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known. RESEARCH DESIGN AND METHODS - A 2-h glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained at the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study (IRAS). For this report, 385 individuals were at increased risk of diabetes as defined by A1C between 5.7 and 6.4{\%}, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG). RESULTS - IFG and IGT identified 69.1 and 59.5{\%} of all individuals at increased risk of diabetes, respectively. A1C 5.7-6.4{\%} detected 23.6{\%} of all at-risk individuals, although more African Americans (31.4{\%}) and Hispanics (35.2{\%}) than non-Hispanic whites (9.9{\%}). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26; P > 0.01), acute insulin response (r = - 0.20 vs. - 0.09; P < 0.01), and waist circumference (r = 0.43 vs. 0.25; P < 0.001) by the Spearman correlation test. Similarly, 2-h plasma glucose was more strongly related to Si (r = - 0.40 vs. - 0.27; P < 0.01) and triglycerides (r = 0.30 vs. 0.08; P < 0.001). CONCLUSIONS - A1C 5.7-6.4{\%} is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h plasma glucose seem to be more precise correlates of insulin resistance and secretion than A1C and, in general, better for other metabolic disorders.",
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T1 - A1C between 5.7 and 6.4% as a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors

T2 - The Insulin Resistance Atherosclerosis Study (IRAS)

AU - Lorenzo, Carlos

AU - Wagenknecht, Lynne E.

AU - Hanley, Anthony J G

AU - Rewers, Marian J.

AU - Karter, Andrew J.

AU - Haffner, Steven M.

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