Hemoglobin A1c, fasting plasma glucose, and 2-hour plasma glucose distributions in U.S. population subgroups: NHANES 2005-2010

Ann Epidemiol. 2014 Feb;24(2):83-9. doi: 10.1016/j.annepidem.2013.10.008. Epub 2013 Oct 18.


Purpose: Although mean concentrations of hemoglobin A1c (A1C), fasting plasma glucose, and 2-hour plasma glucose differ by demographics, it is unclear what other characteristics of the distributions may differ, such as the amount of asymmetry of the distribution (skewness) and shift left or right compared with another distribution (shift).

Methods: Using kernel density estimation, we created smoothed plots of the distributions of fasting plasma glucose (N = 7250), 2-hour plasma glucose (N = 5851), and A1C (N = 16,209) by age, race-ethnicity, and sex in the 2005-2010 National Health and Nutrition Examination Survey, a nationally representative sample of U.S. adults including people with and without diabetes. We tested differences in distributions using cumulative logistic regression.

Results: The distributions were generally unimodal and right-skewed. All distributions were shifted higher and more right-skewed for older age groups (P < .001 for each marker). Compared with non-Hispanic whites, the distribution of fasting plasma glucose was shifted higher for Mexican-Americans (P = .01), whereas the distribution of A1C was shifted higher for non-Hispanic blacks (P < .001). The distribution of fasting plasma glucose was shifted higher for men (P < .001) and the distribution of 2-hour plasma glucose was shifted higher for women (P = .01).

Conclusions: We provide a graphic reference for comparing these distributions and diabetes cut-points by demographic factors.

Keywords: 2-hour plasma glucose; Fasting plasma glucose; Hemoglobin A1c; Kernel density estimation; NHANES.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Continental Population Groups / statistics & numerical data
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / ethnology*
  • Fasting / blood*
  • Female
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Sex Factors
  • Socioeconomic Factors
  • Surveys and Questionnaires


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A