Sex and age affect agreement between fasting plasma glucose and glycosylated hemoglobin for diagnosis of dysglycemia / El sexo y la edad afectan la concordancia entre glucemia basal y hemoglobina glicada para el diagnóstico de disglucemia

Aim: To assess agreement between fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels for diagnosis of dysglycemia (diabetes and risk of diabetes), overall and depending on clinical characteristics. Methods: The study enrolled 1020 adult subjects without drug-treated diabetes who underwent a laboratory test at a Spanish health care center. The criteria for dysglycemia of the American Diabetes Association were used. A logistic regression analysis was used to predict de novo diagnosis of dysglycemia based on sex, age, body mass index, anemia, and iron levels. Results: Overall prevalence of dysglycemia was 28.04%, and was identified by FPG only in 13.63% of subjects, by both FPG and HbA1c in 7.65%, and by HbA1c only in 6.76% (de novo diagnoses). Independent predictors of de novo diagnoses based on HbA1c were female sex (odds ratio [OR]: 2.119, 95% confidence interval [CI]: 1.133-4.020; p<0.020), age (OR for 42-56 years: 2.541, 95% CI: 0.634-17.140; OR for ≥57 years: 5.656, 95% CI: 1.516-36.980; overall p<0.007), and serum ferritin levels (borderline significance). Conclusions: In this study population, agreement between FPG and HbA1c for diagnosis of dysglycemia was poor, with FPG being the test that identified more subjects. De novo diagnoses based on HbA1c were more common in females and increased with age (AU)

Objetivo: Evaluar la concordancia entre el diagnóstico de disglucemia (diabetes y riesgo de diabetes) realizado por glucemia basal (GB) y hemoglobina A1c (HbA1c), globalmente y según características clínicas. Métodos: El estudio incluyó a 1.020 sujetos adultos con diabetes no tratada con fármacos que realizaron una prueba de laboratorio en un centro de salud español. Los criterios de disglucemia fueron los de la American Diabetes Association. Se utilizó un análisis de regresión logística para predecir un nuevo diagnóstico de disglucemia a partir del sexo, edad, índice de masa corporal, presencia de anemia y estatus férrico. Resultados: La prevalencia global de disglucemia fue del 28,04%, identificada únicamente por GB en el 13,63% de los sujetos, por GB y HbA1c en el 7,65% y solo por HbA1c en el 6,76% (nuevos diagnósticos). Los predictores independientes de nuevo diagnóstico según HbA1c fueron el sexo femenino (odds ratio [OR]: 2,119; intervalo de confianza [IC] 95%: 1,133-4,020; p<0,020), la edad (OR para 42-56 años: 2,541; IC 95%: 0,634-17,140; OR para ≥57 años: 5,656, IC 95%: 1,516-36,980; p<0,007 en general) y la ferritina sérica (significación límite). Conclusiones: En esta población la concordancia entre GB y HbA1c para el diagnóstico de disglucemia es pobre; la GB es la prueba que identifica más sujetos. Los nuevos diagnósticos por HbA1c se realizan con mayor frecuencia en mujeres y aumentan con la edad (AU)

Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex?

BACKGROUND: The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion. METHODS: Prospective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50-69 years. A result was considered positive at ≥20 µg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs. RESULTS: We analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0‰ for men and 15.9‰ for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women). CONCLUSIONS: This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.

Sex and age affect agreement between fasting plasma glucose and glycosylated hemoglobin for diagnosis of dysglycemia.

AIM: To assess agreement between fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels for diagnosis of dysglycemia (diabetes and risk of diabetes), overall and depending on clinical characteristics. METHODS: The study enrolled 1020 adult subjects without drug-treated diabetes who underwent a laboratory test at a Spanish health care center. The criteria for dysglycemia of the American Diabetes Association were used. A logistic regression analysis was used to predict de novo diagnosis of dysglycemia based on sex, age, body mass index, anemia, and iron levels. RESULTS: Overall prevalence of dysglycemia was 28.04%, and was identified by FPG only in 13.63% of subjects, by both FPG and HbA1c in 7.65%, and by HbA1c only in 6.76% (de novo diagnoses). Independent predictors of de novo diagnoses based on HbA1c were female sex (odds ratio [OR]: 2.119, 95% confidence interval [CI]: 1.133-4.020; p<0.020), age (OR for 42-56 years: 2.541, 95% CI: 0.634-17.140; OR for ≥57 years: 5.656, 95% CI: 1.516-36.980; overall p<0.007), and serum ferritin levels (borderline significance). CONCLUSIONS: In this study population, agreement between FPG and HbA1c for diagnosis of dysglycemia was poor, with FPG being the test that identified more subjects. De novo diagnoses based on HbA1c were more common in females and increased with age.

Population-based colorectal cancer screening: comparison of two fecal occult blood test.

BACKGROUND: The aim of screening for colorectal cancer is to improve prognosis by the detection of cancer at its early stages. In order to inform the decision on the specific test to be used in the population-based program in the Basque Autonomous Region (Spain), we compared two immunochemical fecal occult blood quantitative tests (I-FOBT). METHODS: Residents of selected study areas, aged 50-69 years, were invited to participate in the screening. Two tests based on latex agglutination (OC-Sensor and FOB Gold) were randomly assigned to different study areas. A colonoscopy was offered to patients with a positive test result. The cut-off point used to classify a result as positive, according to manufacturer's recommendations, was 100 ng/ml for both tests. RESULTS: The invited population included 37,999 individuals. Participation rates were 61.8% (n = 11,162) for OC-Sensor and 59.1% (n = 11,786) for FOB Gold (p = 0.008). Positive rate for OC-Sensor was 6.6% (n = 737) and 8.5% (n = 1,002) for FOB Gold (p < 0.0001). Error rates were higher for FOB gold (2.3%) than for OC-Sensor (0.2%; p < 0.0001). Predictive positive value (PPV) for total malignant and premalignant lesions was 62.4% for OC-Sensor and 58.9% for FOB Gold (p = 0.137), respectively. CONCLUSION: OC-Sensor test appears to be superior for I-FOBT-based colorectal cancer screening, given its acceptance, ease of use, associated small number of errors and its screening accuracy. FOB Gold on the other hand, has higher rate of positive values, with more colonoscopies performed, it shows higher detection incidence rates, but involves more false positives.