Research articleIdentifying Adults at High Risk for Diabetes and Cardiovascular Disease Using Hemoglobin A1c: National Health and Nutrition Examination Survey 2005–2006
Section snippets
Study Design and Sample
The NHANES 2005–2006 surveyed a nationally representative sample of the civilian, noninstitutionalized U.S. population using a stratified, multistage probability sampling design with oversampling of older people and minority groups. Detailed descriptions of the design may be viewed on the National Center for Health Statistics (NCHS) website.21 Among NHANES respondents who were aged ≥18 years, 4751 reported no prior diagnosis of diabetes. Of those who attended the mobile examination center, 2188
Nonselective A1c Testing to Identify Adults at High Risk for Diabetes or Cardiovascular Disease
Among all U.S. adults aged ≥18 years without self-reported diabetes or prior CVD, 30.0% (SE=1.6%) met the 2003 ADA criteria for prediabetes. Within this large group, the mean predicted probabilities for incident diabetes (over 7.5 years) and CVD (over 10 years) were 33.5% (SE=1.0%) and 10.7% (SE=0.8%), respectively. Associations of different A1c test thresholds with predicted risk for diabetes and CVD in adults without self-reported diabetes or prior CVD are shown in Table 1. These data show a
Conclusion
A large majority of people who would meet the 2003 ADA classification for prediabetes are unaware of their risk because of challenges to performing FPG and 2hPG tests routinely.6, 7 A simpler form of high-risk testing could improve diabetes prevention efforts by substantially increasing the numbers of individuals who complete testing. The current study indicates that the A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and CVD.
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