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Complications

New Diabetes Diagnostic Threshold of Hemoglobin A1c and the 3-Year Incidence of Retinopathy

  1. Yusuke Tsugawa1⇓,
  2. Osamu Takahashi2,
  3. James B. Meigs3,
  4. Roger B. Davis1,4,
  5. Fumiaki Imamura5,
  6. Tsuguya Fukui2,
  7. William C. Taylor1 and
  8. Christina C. Wee1
  1. 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
  2. 2Division of General Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan
  3. 3General Internal Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts
  4. 4Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
  5. 5Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
  1. Corresponding author: Yusuke Tsugawa, ytsugawa{at}bidmc.harvard.edu.
Diabetes 2012 Dec; 61(12): 3280-3284. https://doi.org/10.2337/db12-0103
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Abstract

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.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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New Diabetes Diagnostic Threshold of Hemoglobin A1c and the 3-Year Incidence of Retinopathy
Yusuke Tsugawa, Osamu Takahashi, James B. Meigs, Roger B. Davis, Fumiaki Imamura, Tsuguya Fukui, William C. Taylor, Christina C. Wee
Diabetes Dec 2012, 61 (12) 3280-3284; DOI: 10.2337/db12-0103

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New Diabetes Diagnostic Threshold of Hemoglobin A1c and the 3-Year Incidence of Retinopathy
Yusuke Tsugawa, Osamu Takahashi, James B. Meigs, Roger B. Davis, Fumiaki Imamura, Tsuguya Fukui, William C. Taylor, Christina C. Wee
Diabetes Dec 2012, 61 (12) 3280-3284; DOI: 10.2337/db12-0103
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