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HbA1c as a Predictor of Diabetes and as an Outcome in the Diabetes Prevention Program: A Randomized Clinical Trial
- Source :
- Diabetes Care
- Publication Year :
- 2014
- Publisher :
- American Diabetes Association, 2014.
-
Abstract
- OBJECTIVE Glycated hemoglobin (HbA1c), a standard measure of chronic glycemia for managing diabetes, has been proposed to diagnose diabetes and identify people at risk. The Diabetes Prevention Program (DPP) was a 3.2-year randomized clinical trial of preventing type 2 diabetes with a 10-year follow-up study, the DPP Outcomes Study (DPPOS). We evaluated baseline HbA1c as a predictor of diabetes and determined the effects of treatments on diabetes defined by an HbA1c ≥6.5% (48 mmol/mol). RESEARCH DESIGN AND METHODS We randomized 3,234 nondiabetic adults at high risk of diabetes to placebo, metformin, or intensive lifestyle intervention and followed them for the development of diabetes as diagnosed by fasting plasma glucose (FPG) and 2-h postload glucose (2hPG) concentrations (1997 American Diabetes Association [ADA] criteria). HbA1c was measured but not used for study eligibility or outcomes. We now evaluate treatment effects in the 2,765 participants who did not have diabetes at baseline according to FPG, 2hPG, or HbA1c (2010 ADA criteria). RESULTS Baseline HbA1c predicted incident diabetes in all treatment groups. Diabetes incidence defined by HbA1c ≥6.5% was reduced by 44% by metformin and 49% by lifestyle during the DPP and by 38% by metformin and 29% by lifestyle throughout follow-up. Unlike the primary DPP and DPPOS findings based on glucose criteria, metformin and lifestyle were similarly effective in preventing diabetes defined by HbA1c. CONCLUSIONS HbA1c predicted incident diabetes. In contrast to the superiority of the lifestyle intervention on glucose-defined diabetes, metformin and lifestyle interventions had similar effects in preventing HbA1c-defined diabetes. The long-term implications for other health outcomes remain to be determined.
- Subjects :
- Adult
Blood Glucose
Male
Research design
medicine.medical_specialty
endocrine system diseases
Endocrinology, Diabetes and Metabolism
Type 2 diabetes
Placebo
Body Mass Index
law.invention
chemistry.chemical_compound
Double-Blind Method
Randomized controlled trial
Risk Factors
law
Internal medicine
Diabetes mellitus
Internal Medicine
Humans
Hypoglycemic Agents
Medicine
Epidemiology/Health Services Research
Life Style
Glycated Hemoglobin
Advanced and Specialized Nursing
business.industry
Incidence
Incidence (epidemiology)
nutritional and metabolic diseases
Middle Aged
medicine.disease
Metformin
Treatment Outcome
Diabetes Mellitus, Type 2
chemistry
Physical therapy
Female
Glycated hemoglobin
Waist Circumference
business
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 19355548 and 01495992
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Diabetes Care
- Accession number :
- edsair.doi.dedup.....10e22ebdb321f9c357b4cef417d0ad54