Should HbA1c cutoffs for DM diagnosis be higher in older adults?

  • Masuch A & al.
  • BMC Endocr Disord
  • 12 Feb 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • HbA1c increases with age in people without diabetes. 
  • Study provides first age-dependent HbA1c reference values.

Why this matters

  • Disregarding age-related HbA1c increase may lead to diabetes mellitus (DM) misdiagnosis and overtreatment.

Study design

  • Individuals without diabetes from 2 population-based cohorts:
    • 4263 from the Study of Health in Pomerania (SHIP-0); and 
    • 4402 from the independent study SHIP-Trend. 
  • Cohorts examined and compared for age-specific HbA1c changes.
  • Healthy subpopulations of SHIP-0 and SHIP-Trend were combined to derive HbA1c reference intervals by age group.
  • Funding: Federal Ministry of Education and Research, Ministry of Cultural Affairs, Social Ministry of the Federal State of Mecklenburg-West Pomerania.

Key results

  • Up to 0.78% or 0.67% higher estimated mean HbA1c levels for ages ≥60 years compared with 20-39 years in SHIP-0 or SHIP-Trend, respectively:
    • Women ≥60 years:
      • SHIP-0: 5.83% (95% CI, 5.77%-5.89%); and
      • SHIP-Trend: 5.62% (5.57%-5.68%).
    • Women 20-39 years:
      • SHIP-0: 5.05% (4.99%-5.12%); and 
      • SHIP-Trend: 4.95% (4.89%-5.01%).
  • HbA1c upper reference limit was:
    • 6.0% (42.1 mmol/mol) for individuals aged 20-39 years;
    • 6.1% (43.2 mmol/mol) for ages 40-59 years; and
    • 6.5% (47.5 mmol/mol) for ≥60 years.

Limitations

  • Both SHIP-0 and SHIP-Trend consist of whites (data suggest HbA1c is lowest in whites, higher in Mexican-Americans, and highest in black patients).

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