A single-sample confirmatory definition of diabetes had a high positive predictive value for subsequent diagnosis and was strongly associated with clinical end points, a recent study found. 13,346 participants from the Atherosclerosis Risk in Communities (ARIC) study (12,268 without diagnosed diabetes) were included with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease, and mortality. Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose and HbA1c from a single blood sample. Researchers found:
- Among 12,268 participants without diagnosed diabetes, 978 had elevated levels of fasting glucose or HbA1c at baseline.
- Among these, 39% had both (confirmed undiagnosed diabetes), whereas 61% had only 1 elevated measure (unconfirmed undiagnosed diabetes).
- The confirmatory definition had moderate sensitivity (54.9%) but high specificity (98.1%) for identification of diabetes cases diagnosed during the first 5 years of follow-up, with specificity increasing to 99.6% by 15 years.
- 15-year positive predictive value was 88.7% vs 71.1% for unconfirmed cases.
- Confirmed undiagnosed diabetes was significantly associated with CV and kidney disease and mortality, with stronger associations than unconfirmed diabetes.
Selvin E, Wang D, Matsushita K, Grams ME, Coresh J. Prognostic implications of single-sample confirmatory testing for undiagnosed diabetes: A prospective cohort study. [Published online ahead of print June 19, 2018]. Ann Intern Med. doi:10.7326/M18-0091.
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