Transcript HbA1c5.7-6.4% and impaired fasting plasma glucose for

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 Wilson
2012 PharmD Candidate
Mercer 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
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
study
Subgroups

Patients divided into 4 subgroups on
basis of baseline diagnosis
1)Impaired fasting glucose alone
2)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.