Epidemiological ramifications of diagnosing diabetes with HbA1c levels

J Diabetes Complications. 2014 Jul-Aug;28(4):464-9. doi: 10.1016/j.jdiacomp.2014.03.016. Epub 2014 Apr 2.


Aims: To compare the prevalence of diabetes by history and using the fasting plasma glucose (FPG) criterion alone, the HbA1c criterion alone or either one in those not known to have diabetes.

Methods: Analysis of NHANES population ≥20years old from 1999 through 2010.

Results: In those diagnosed by laboratory tests, 86% met the FPG criterion and 53% met the HbA1c criterion. The prevalence of diabetes (history or laboratory test) was significantly increased when the FPG criterion was used compared with the HbA1c criterion in the entire (11.5% vs 10.5%, P=0.018) and Caucasian (10.6% vs 9.2%, P=0.022) populations. In contrast, there were no significant differences in the prevalence when only the FPG criterion was used compared with only the HbA1c criterion in Hispanics (12.9% vs 12.1% P=0.386) and African Americans (14.5 vs 14.3%, P=0.960). Using history and either criterion in those not known to have it, diabetes increased by 61% in this 12year period in adults ≥20years old.

Conclusions: Using the FPG rather than the HbA1c criterion to diagnose diabetes in those without a history significantly increased the total prevalence of diabetes in Caucasians but not in African Americans or Hispanics.

Keywords: Diagnosis of diabetes; Fasting plasma glucose; HbA1c; NHANES/diabetes; Prevalence of diabetes; Race/ethnicity.

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Black or African American
  • Blood Glucose / analysis
  • Cohort Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • Female
  • Glycated Hemoglobin / analysis*
  • Health Transition*
  • Hispanic or Latino
  • Humans
  • Male
  • Medical History Taking
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • Sex Factors
  • United States / epidemiology
  • White People
  • Young Adult


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human