Determinants of diagnostic discordance for non-diabetic hyperglycaemia and Type 2 diabetes using paired glycated haemoglobin measurements in a large English primary care population: cross-sectional study

Abstract

Aim: To investigate factors influencing diagnostic discordance for non-diabetic hyperglycaemia and Type 2 diabetes.

Methods: Some 10 000 adults at increased risk of diabetes were screened with HbA_1c and fasting plasma glucose (FPG). The 2208 participants with initial HbA_1c ≥ 42 mmol/mol (≥ 6.0%) or FPG ≥ 6.1 mmol/l were retested after a median 40 days. We compared the first and second HbA_1c results, and consequent diagnoses of non-diabetic hyperglycaemia and Type 2 diabetes, and investigated predictors of discordant diagnoses.

Results: Of 1463 participants with non-diabetic hyperglycaemia and 394 with Type 2 diabetes on first testing, 28.4% and 21.1% respectively had discordant diagnoses on repeated testing. Initial diagnosis of non-diabetic hyperglycaemia and/or impaired fasting glucose according to both HbA_1c and FPG criteria, or to FPG only, made reclassification as Type 2 diabetes more likely than initial classification according to HbA_1c alone. Initial diagnosis of Type 2 diabetes according to both HbA_1c and FPG criteria made reclassification much less likely than initial classification according to HbA_1c alone. Age, and anthropometric and biological measurements independently but inconsistently predicted discordant diagnoses and changes in HbA_1c .

Conclusions: Diagnosis of non-diabetic hyperglycaemia or Type 2 diabetes with a single measurement of HbA_1c in a screening programme for entry to diabetes prevention trials is unreliable. Diagnosis of non-diabetic hyperglycaemia and Type 2 diabetes should be confirmed by repeat testing. FPG results could help prioritise retesting. These findings do not apply to people classified as normal on a single test, who were not retested.