Selvin E, et al. - The prognostic performance of a single-sample confirmatory definition of undiagnosed diabetes was investigated in this prospective cohort study. The data presented in this work showed a single-sample confirmatory definition of diabetes had a high positive predictive value for subsequent diagnosis and was strongly connected with clinical end points. The clinical utility of using a combination of elevated fasting glucose and hemoglobin A_1c (HbA_1c) levels from a single blood sample to identify undiagnosed diabetes in the population was supported.

Methods

• Participants in the study were 13,346 ARIC (Atherosclerosis Risk in Communities) members (12,268 without diagnosed diabetes) with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease, and mortality.
• Confirmed undiagnosed diabetes was characterized as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and HbA_1c (≥6.5%) from a single blood sample.

Results

• The study results showed that among 12,268 participants without diagnosed diabetes, 978 had elevated levels of fasting glucose or HbA_1c at baseline (1990 to 1992).
• It was observed that 39% had both (confirmed undiagnosed diabetes), whereas 61% had only 1 elevated measure (unconfirmed undiagnosed diabetes).
• Findings revealed that 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.
• It was noted that the 15-year positive predictive value was 88.7% compared with 71.1% for unconfirmed cases.
• According to the findings obtained, confirmed undiagnosed diabetes was significantly correlated with cardiovascular and kidney disease and mortality, with stronger associations than unconfirmed diabetes.