HbA1c as a predictor of diabetes and as an outcome in the diabetes prevention program

A randomized clinical trial

Diabetes Prevention Program Research Group

Research output: Contribution to journalArticle

45 Citations (Scopus)

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 &Dagger;6.5% was reduced by 44% by metformin and 49% by lifestyle during the DPP and by 38% bymetformin 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.

Original languageEnglish
Pages (from-to)51-58
Number of pages8
JournalDiabetes Care
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2015

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Life Style
Randomized Controlled Trials
Metformin
Glucose
Fasting
Outcome Assessment (Health Care)
Glycosylated Hemoglobin A
Primary Prevention
Type 2 Diabetes Mellitus
Research Design
Therapeutics
Placebos
Incidence
Health

ASJC Scopus subject areas

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

Cite this

HbA1c as a predictor of diabetes and as an outcome in the diabetes prevention program : A randomized clinical trial. / Diabetes Prevention Program Research Group.

In: Diabetes Care, Vol. 38, No. 1, 01.01.2015, p. 51-58.

Research output: Contribution to journalArticle

Diabetes Prevention Program Research Group. / HbA1c as a predictor of diabetes and as an outcome in the diabetes prevention program : A randomized clinical trial. In: Diabetes Care. 2015 ; Vol. 38, No. 1. pp. 51-58.
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