Diabetes Screening and New-Onset Diabetes Prediction - Essay Example

Among people aged above 65 years, 10.9 million had diabetes by 2010. Within the adult cohort by 2010, statistics indicate that 79 million people above the age of 20 had diabetes (Center for Disease Control, 2010).

Hemoglobin A1c as a Diagnostic Tool for Diabetes Screening and New-Onset Diabetes Prediction

In recognition of the fact that diabetes is a leading cause of heart-related diseases, kidney malfunction, and blindness; concerted efforts have been dedicated to conventional early diagnostic measures. To this end, the American Diabetes Association has conducted research on the Hemoglobin A1c (Choi et al. 2011). The research conducted has been based on establishing it as an early diagnostic tool for screening diabetes as well as new-onset prediction. The research came against the backdrop of knowledge that certain cut-off levels of A1c were effective in screening diabetes. Consequently, the research’s objective was to evaluate the feasibility of A1c levels during the screening of undiagnosed diabetes. Furthermore, the research sought to establish A1c levels as an indicator of diabetes in a cohort population with a 6 year incident period (Choi et al. 2011).

Research Design and Tools

The research design incorporated a total of 10, 038 participants taken from the Unsung Ansan population study (Choi et al. 2011). The selected cohort of the study was an ongoing community-based population study from the Korean Health and Genome survey. The choice of the cohort was due to its association with the diabetes program that aimed at investigating new trends and related risk factors. Furthermore, the participants were selected based on the age eligibility threshold of between 40-69 years. In addition, the participants had to be residing within the survey region for a minimum of 6 years prior to testing. They also had to be of sound physical and mental health. The method of the survey involved the use of a cluster sample technique stratified by sex, residential area, and age. Moreover, all the participants were subjected to tolerance tests of 75-g oral glucose during baseline and at subsequent follow-ups biennially. To this end, 572 participants with verifiable type 2 diabetes were excluded as well as 91 participants whose glucose status was unknown. The purpose of this measure was to derive the curve from the receiver operating characteristic. Consequently, the curve was used to investigate the diagnostic potency and accuracy of the A1 cut-off. In addition, the Coz proportional hazards design was applied in the prediction of diabetes after 6 years.

Results

At this point, the results derived at the baseline indicated 635 individuals had been undiagnosed with diabetes in the past. Furthermore, 5.9% of A1 cut-off reflected the greatest percentage of sensitivity and specificity at 68% and 91% respectively.  Furthermore, the cut-off curve revealed 77% specificity in the identification of concurrent 6-year indicative diabetes. Results further indicated that 10.2% of the cohort study had contracted incident diabetes at 6 years. Lastly, upon conducting a multivariate adjustment, women were identified to have a 3.1 fold higher risk of new-incident diabetes while men had a 2.4 fold higher risk.

Discussion

From the above results, the researchers ascertained that a 5.9% A1c cut-off was sufficient in identifying persons with undiagnosed diabetes. Furthermore, persons with A1c ≥ 5.6 % were at advanced risk of developing type 2 diabetes. The research findings equally acknowledged that it had applied stringent methods in the diagnosis of diabetes within the large cohort of the study. To this end, the research had administered the OGTT (Oral Glucose Tolerance Test) to the entire individuals and utilized similar procedures and tools in the biochemical and clinical evaluations during the 6-year duration. Furthermore, in the research study, the screening of diabetes was founded on plasma glucose findings from the 75-g OGTT. Moreover, the A1c statistic of 5.9% was effective in the screening of undiagnosed type 2 diabetes within the cohort of the study.

Conclusion

Consequently, the major conclusion from the research study was that hemoglobin A1c was an effective diagnostic tool for screening type 2 diabetes. Moreover, it was equally a reliable diagnostic predictor of future diabetes. To this end, the research established that an A1c cut of the percentage of 5.9% was reliable in identifying a large number of people with undiagnosed type 2 diabetes. In addition, the research established that persons who had an A1c  greater than or equal to 5.6% had a higher risk of developing future diabetes. Consequently, early prevention intervention would be necessary. To this end, the implication from the research study to nursing was that the A1c assay could be effectively used for the early screening of type 2 diabetes among patients. In addition, the diagnostic tool could be used as a future predictor of the onset of diabetes among individuals. Consequently, early preventive care and medical treatment of diagnosed patients will be increasingly efficient.