TY - JOUR
T1 - Diagnostic performance of glycated hemoglobin for diabetic retinopathy in non-diabetic older overweight/obese African-Americans
AU - Okosun, Ike S.
AU - Turbow, Sara
AU - McJenkin, Kris
AU - Monique Davis-Smith, Y.
AU - Seale, J. Paul
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives Although clinicians do not routinely screen for diabetic retinopathy in non-diabetic patients, previous studies have shown that diabetic retinopathy can occur in patients with prediabetes. However, due to the limitations of glycated hemoglobin (HbA1c) in overweight/obese subjects, African-Americans and older adults, little is known about the correlation between HbA1c and diabetic retinopathy in non-diabetic older overweight/obese African-Americans. The aims of this study were to determine the association between HbA1c and diabetic retinopathy, and the optimal diagnostic threshold of HbA1c that predicts diabetic retinopathy in non-diabetic older overweight/obese African-Americans. Methods The 2005–2012 data from the U.S. National Health and Nutrition Examination Surveys (NHANES) were utilized for this study. Prevalence odds ratios from logistic regression analyses were used to estimate risks of diabetic retinopathy across HbA1c categories, adjusting for age, sex, and hypertension. Receiver operating characteristic curve was used to determine diagnostic cutoff point of HbA1c for prevalent diabetic retinopathy. Results There were gradients of increasing prevalence and odds of diabetic retinopathy with increasing HbA1c in non-diabetic overweight/obese African-Americans 50 years of age and older. HbA1c cut-off point of 5.2% (AUC = .726, 95% CI = 0.696–0.756) was found to maximize sensitivity [93.5%; 95% CI: 83.2–95.7] for diabetic retinopathy, though specificity [22.1%; 95% CI 19.9–32.8] was low. Conclusion Current criteria for diagnosis of prediabetes are effective in identifying many older overweight/obese African Americans with diabetic retinopathy. Based on our analysis, a lower HbA1c of 5.2% could serve as a more sensitive cutoff point for defining prediabetes in this population subgroup.
AB - Objectives Although clinicians do not routinely screen for diabetic retinopathy in non-diabetic patients, previous studies have shown that diabetic retinopathy can occur in patients with prediabetes. However, due to the limitations of glycated hemoglobin (HbA1c) in overweight/obese subjects, African-Americans and older adults, little is known about the correlation between HbA1c and diabetic retinopathy in non-diabetic older overweight/obese African-Americans. The aims of this study were to determine the association between HbA1c and diabetic retinopathy, and the optimal diagnostic threshold of HbA1c that predicts diabetic retinopathy in non-diabetic older overweight/obese African-Americans. Methods The 2005–2012 data from the U.S. National Health and Nutrition Examination Surveys (NHANES) were utilized for this study. Prevalence odds ratios from logistic regression analyses were used to estimate risks of diabetic retinopathy across HbA1c categories, adjusting for age, sex, and hypertension. Receiver operating characteristic curve was used to determine diagnostic cutoff point of HbA1c for prevalent diabetic retinopathy. Results There were gradients of increasing prevalence and odds of diabetic retinopathy with increasing HbA1c in non-diabetic overweight/obese African-Americans 50 years of age and older. HbA1c cut-off point of 5.2% (AUC = .726, 95% CI = 0.696–0.756) was found to maximize sensitivity [93.5%; 95% CI: 83.2–95.7] for diabetic retinopathy, though specificity [22.1%; 95% CI 19.9–32.8] was low. Conclusion Current criteria for diagnosis of prediabetes are effective in identifying many older overweight/obese African Americans with diabetic retinopathy. Based on our analysis, a lower HbA1c of 5.2% could serve as a more sensitive cutoff point for defining prediabetes in this population subgroup.
KW - Glycated hemoglobin
KW - Obesity
KW - Older age
KW - Prediabetes
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U2 - 10.1016/j.diabres.2016.07.021
DO - 10.1016/j.diabres.2016.07.021
M3 - Article
C2 - 27544907
AN - SCOPUS:84984796629
SN - 0168-8227
VL - 120
SP - 124
EP - 131
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -