Acta Diabetol
Fig. 1 Study design (according to standards for reporting of
diagnostic accuracy (STARD) guidelines. a Concordance of predia-
betes (by OGTT criteria) versus HbA1c by ADA definition (5.7–
Correlations of HbA1c and 1-h PG with glycemic
and surrogate insulin measures
The categorization of high-risk individuals stratified based
on 1-h PG C 155 mg/dl (8.6 mmol/l) is an equivalent
marker as OGTT for identifying individuals with decreased
insulin sensitivity (%D: OGTT -31.0; 1-h PG -35.0) and
deteriorated b-cell function (%D: OGTT -40.7; 1-h
PG:-38.6). The HbA1c criteria defined by ADA and IEC
were moderately associated with changes in ISI and DIo.
The correlation coefficients between OGTT indices (FPG,
2-h PG), HOMA-IR, and b-cell function with HbA1c and
1-h PG are shown in Table 2. 1-h PG showed stronger
associations with 2-h PG, ISI, and b-cell function than
HbA1c (P \ 0.05 for all). The association of FPG was
similar between the two tests. We have also compared the
1-h PG and 2-h PG during the OGTT with the ISI and b-
cell function. The 1-h PG was strongly associated with ISI
and b-cell function compared with the 2-h PG. However,
the comparison between the two tests was nonsignificant
(data not shown).
123
6.4 %). b Concordance of prediabetes (by OGTT criteria) versus
HbA1c by IEC definition (6.0–6.4 %). c Concordance of prediabetes
(by OGTT criteria) versus 1-h PG [ 155 mg/dl (8.6 mmol/l)
Measures of diagnostic accuracy of HbA1c and 1-h
PG
Figure 3 shows the discriminatory power of HbA1c and 1-h
PG in identifying individuals with prediabetes. The ROC for
HbA1c and 1-h PG were 0.65 [95 % CI 0.57–0.73] and 0.79
[95 % CI 0.72–0.85], respectively. The HbA1c value of
C5.7–6.4 % defining the prediabetes threshold (ADA crite-
ria) demonstrated high specificity of 94.3 % [95 % CI
86.0–98.4 %] but very poor sensitivity [19.0 % (95 % CI
12.9–26.5 %)] with a lower likelihood ratio of 1.16. The IEC
guidelines of HbA1c: 6.0–6.4 % demonstrated a moderate
sensitivity (58.6 % [95 % CI 46.2–70.2 %]) and specificity
(59.9 % [95 % CI 51.3–68.0 %]) with a likelihood ratio of
1.46. Conversely, 1-h PG C 155 mg/dl (8.6 mmol/l)
showed a good sensitivity (74.3 % [95 % CI 62.4–84.0 %])
and specificity 69.7 % [95 % CI 61.5–77.1 %]) with a
likelihood ratio of 2.45. The ability of 1-h PG to discriminate
prediabetes was better than that of HbA1c (DAUC: -0.14;
Z value: -2.57; P = 0.01) with high specificity and sensi-
tivity. The IEC guidelines of HbA1c C6.0 % were superior