Prediction of Type 2 Diabetes by Hemoglobin A_1c in Two Community-Based Cohorts.

Abstract

Hemoglobin A_1c (HbA_1c) can be used to assess type 2 diabetes (T2D) risk. We asked whether HbA_1c was associated with T2D risk in four scenarios of clinical information availability: <i>1</i>) HbA_1c alone, <i>2</i>) fasting laboratory tests, <i>3</i>) clinic data, and <i>4</i>) fasting laboratory tests and clinic data. We studied a prospective cohort of white (<i>N</i> = 11,244) and black (<i>N</i> = 2,294) middle-aged participants without diabetes in the Framingham Heart Study and Atherosclerosis Risk in Communities study. Association of HbA_1c with incident T2D (defined by medication use or fasting glucose [FG] ≥126 mg/dL) was evaluated in regression models adjusted for <i>1</i>) age and sex (demographics); <i>2</i>) demographics, FG, HDL, and triglycerides; <i>3</i>) demographics, BMI, blood pressure, and T2D family history; or <i>4</i>) all preceding covariates. We combined results from cohort and race analyses by random-effects meta-analyses. Subsidiary analyses tested the association of HbA_1c with developing T2D within 8 years or only after 8 years. Over 20 years, 3,315 individuals developed T2D. With adjustment for demographics, the odds of T2D increased fourfold for each percentage-unit increase in HbA_1c. The odds ratio (OR) was 4.00 (95% CI 3.14, 5.10) for blacks and 4.73 (3.10, 7.21) for whites, resulting in a combined OR of 4.50 (3.35, 6.03). After adjustment for fasting laboratory tests and clinic data, the combined OR was 2.68 (2.15, 3.34) over 20 years, 5.79 (2.51, 13.36) within 8 years, and 2.23 (1.94, 2.57) after 8 years. HbA_1c predicts T2D in different common scenarios and is useful for identifying individuals with elevated T2D risk in both the short- and long-term.