gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Prognostic value of haemoglobin A1c and fasting plasma glucose for incident diabetes in a cohort of elderly and implications for screening

Meeting Abstract

  • Ben Schöttker - Deutsches Krebsforschungszentrum, Heidelberg
  • Elke Raum - Deutsches Krebsforschungszentrum, Heidelberg
  • Dietrich Rothenbacher - Deutsches Krebsforschungszentrum, Heidelberg
  • Heiko Müller - Deutsches Krebsforschungszentrum, Heidelberg
  • Hermann Brenner - Deutsches Krebsforschungszentrum, Heidelberg

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds148

doi: 10.3205/11gmds148, urn:nbn:de:0183-11gmds1487

Published: September 20, 2011

© 2011 Schöttker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The aim of this analysis is to compare screening strategies with haemoglobin A1c (A1C), fasting plasma glucose (FPG) or combined measures in the identification of individuals at high risk for diabetes.

Methods: Applying American Diabetes Association (ADA) thresholds for FPG and A1C screening, 6,803 subjects free of diabetes were classified as non-diabetic, pre-diabetic and possibly diabetic by FPG (<100, 100-125 and >125mg/dl) and A1C (<5.7, 5.7-6.4 and >6.4%) [1]. Hazard ratios, sensitivity and specificity were estimated for individuals with pre-diabetes with respect to incident diabetes in the following five years. Areas under the receiver operating characteristic curves (AUC) were estimated for levels of FPG≤125mg/dl and A1C≤6.4% in diabetes prediction.

Results: Although FPG and A1C screenings poorly agreed in classifying individuals as pre-diabetic, hazard ratios [95% confidence interval] for incident diabetes were similarly increased in univariate models in the two pre-diabetic groups: FPG 100-125mg/dl, 4.72 [3.69; 6.05]; A1C 5.7-6.4%, 3.97 [3.05; 5.23]. A1C and FPG had comparable AUCs (FPG, 0.732; A1C, 0.725) and consequently similar five-year sensitivities and specificities for their pre-diabetes definitions (when the lower cut-off for A1C-defined pre-diabetes was increased to a level between 5.8% and 5.9%). Combining A1C and FPG increased the AUC to 0.778, and a further increase to 0.817 was seen with additional inclusion of conventional risk factors.

Conclusions: FPG and A1C have comparable (yet insufficient) abilities in identifying individuals at high risk for diabetes. Effectiveness of a diabetes screening program could be improved by a risk score including FPG and A1C.


American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care. 2010;33(Suppl 1):S11-61.