Date of Award

5-2021

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Mindy Staveteig

Keywords

Type 2 diabetes; Glucose tolerance test; 2hPG; A1c

Abstract

The purpose of this literature review was to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) compared to oral glucose tolerance testing (OGTT) for diagnosis of type 2 diabetes. Databases ClinicalKey, PubMed, Dynamed, and CINAHL withdrew a total of 17 peer-reviewed cross-sectional and retrospective studies, secondary data and pooled data analyses, and meta-analyses. Inclusion criteria included human studies, black, white, Hispanic, and Asian populations, studies < 10 years old, individuals > 15 years of age, fasting plasma glucose in conjunction with OGTT, and subjects without known type 2 diabetes. Exclusion criteria included alternative forms of diabetes, screening and diagnosis of prediabetes, comparisons in relation to specific medical conditions such as heart disease, pregnancy, and gestational diabetes, a prior diabetes diagnosis, and childrenrace, gender, age, and obesity may be related to inaccurately low HbA1c compared to OGTT standards in patients who have not been diagnosed with diabetes. Of those, race and metabolic profiles appear to have the greatest impact in reduction of HbA1c’s sensitivity. An alternative to sole utilization of HbA1c may be increasing utilization of OGTT, especially in those with risk of erroneously low HbA1c and high risk for type 2 diabetes. Longitudinal data is needed to strengthen findings noted in this literature review.

Comments

The purpose of this literature review was to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) compared to oral glucose tolerance testing (OGTT) for diagnosis of type 2 diabetes. Databases ClinicalKey, PubMed, Dynamed, and CINAHL withdrew a total of 17 peer-reviewed cross-sectional and retrospective studies, secondary data and pooled data analyses, and meta-analyses. Inclusion criteria included human studies, black, white, Hispanic, and Asian populations, studies < 10 years old, individuals > 15 years of age, fasting plasma glucose in conjunction with OGTT, and subjects without known type 2 diabetes. Exclusion criteria included alternative forms of diabetes, screening and diagnosis of prediabetes, comparisons in relation to specific medical conditions such as heart disease, pregnancy, and gestational diabetes, a prior diabetes diagnosis, and childrenrace, gender, age, and obesity may be related to inaccurately low HbA1c compared to OGTT standards in patients who have not been diagnosed with diabetes. Of those, race and metabolic profiles appear to have the greatest impact in reduction of HbA1c’s sensitivity. An alternative to sole utilization of HbA1c may be increasing utilization of OGTT, especially in those with risk of erroneously low HbA1c and high risk for type 2 diabetes. Longitudinal data is needed to strengthen findings noted in this literature review.

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