New Diabetes Diagnostic Threshold of Hemoglobin A1c and the 3-Year Incidence of Retinopathy
- Yusuke Tsugawa1⇓,
- Osamu Takahashi2,
- James B. Meigs3,
- Roger B. Davis1,4,
- Fumiaki Imamura5,
- Tsuguya Fukui2,
- William C. Taylor1 and
- Christina C. Wee1
- 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- 2Division of General Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan
- 3General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts
- 4Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
- 5Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
- Corresponding author: Yusuke Tsugawa, .
The new diagnostic threshold of hemoglobin A1c was made based on evidence from cross-sectional studies, and no longitudinal study supports its validity. To examine whether hemoglobin A1c of 6.5% or higher defines a threshold for elevated risk of incident retinopathy, we analyzed longitudinal data of 19,897 Japanese adults who underwent a health checkup in 2006 and were followed-up 3 years later. We used logistic regression models and restricted cubic spline models to examine the relationship between baseline hemoglobin A1c levels and the prevalence and the 3-year incidence of retinopathy. The restricted cubic spline model indicated a possible threshold for the risk of incident retinopathy at hemoglobin A1c levels of 6.0–7.0%. Logistic regression analysis found that individuals with hemoglobin A1c levels of 6.5–6.9% were at significantly higher risk of developing retinopathy at 3 years compared with those with hemoglobin A1c levels of 5.0–5.4% (adjusted odds ratio, 2.35 [95% CI 1.08–5.11]). Those with hemoglobin A1c levels between 5.5 and 6.4% exhibited no evidence of elevated risks. We did not observe a threshold in the analysis of prevalent retinopathy. Our longitudinal results support the validity of the new hemoglobin A1c threshold of 6.5% or higher for diagnosing diabetes.
- Received January 27, 2012.
- Accepted June 6, 2012.
- © 2012 by the American Diabetes Association.
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