“Our data suggest that a simple, reproducible, and less expensive marker such as HbA1c may be better able to identify prediabetic subjects at high cardiovascular risk compared with the use of fasting glycemia or [oral glucose tolerance test] alone,” Antonino Di Pino, MD, of the department of clinical and molecular biomedicine at the University of Catania in Italy, and colleagues wrote.
In 274 patients, the researchers evaluated arterial stiffness, intima-media thickness, soluble receptor for advanced glycation end products and HbA1c via an OGTT. None of the patients had a previous history of diabetes. Using HbA1c levels, the patients were then stratified into three groups: control group (n=97); patients with prediabetes (n=117); and patients with type 2 diabetes (n=60).
The researchers also found that augmentation and augmentation index were increased in patients with type 2 diabetes, similar to what was observed in the patients with prediabetes. Compared with patients in the control group, the intima-media thickness was higher in patients with prediabetes and those with type 2 diabetes.
After the researchers divided the study population into patients with normal glucose tolerance and patients with altered glucose tolerance, including impaired glucose tolerance and diabetes, those classified as normal glucose tolerance but with HbA1c levels between 5.7% and 6.4% showed elevated augmentation and augmentation index levels (similar to those patients with type 2 diabetes and IGT) and higher intima-media thickness values.
“These results suggest that an HbA1c cutoff of 5.7% is more sensitive for the identification of subjects at high cardiovascular risk as many of these subjects (72 out of 117) were classified as [normal glucose tolerance] after the OGTT with a normal fasting glucose level,” the researchers wrote.
Graham
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