1. HbA 1c 5.7-6.4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan(TOPICS3) Yoriko Heianza, Shigeko Hara, Yasuji Arase, Kazumi Saito, Kazuya Fujiwara, Hiroshi Tsuji, Satoru Kodama, Shiun Dong Hsieh, Yasumichi Mori, Hitoshi Shimano, Nobuhiro Yamada, Kinori Kosaka, Hirohito Sone. Lancet 2011; 378: 147-55 Jon Wilson 2012 PharmD Candidate Mercer University COPHS

2. Prediabetes ADA guidelines criterion... 1) Impaired Fasting Glucose of 5.6 - 6.9mmol/L Or 2)HbA 1c of 5.7-6.4%

3. Diabetes ADA guidelines criterion… 1)Fasting plasma glucose of 7.0mmol/L or higher Or 2)Hb A1c of 6.5% or higher

4. Objective  Compare the prevalence of prediabetes when diagnosed by HbA 1c 5.7-6.4% or by impaired fasting glucose and assess differences in progression rate to diabetes between the two criteria.

5. Study  Longitudinal cohort study  Between 1997 and 2003  Toranomon Hospital in Tokyo, Japan  Look at annual examinations for government employees  Rate of progression to diabetes was assessed annually  Began with 32,057 patients, aged 24-87 years old

6. Inclusion/Exclusion  Inclusion Patients who had annual examinations regularly for 4 or 5 years  Exclusion Patients who were diagnosed with diabetes at baseline 6241 patients were eligible for the study

7. Subgroups  Patients divided into 4 subgroups on basis of baseline diagnosis 1)Impaired fasting glucose alone 2)HbA 1c alone 3)Both IFG and HbA 1c 4)Normoglycaemia

8. Prevalence of prediabetes

9. Results  338 incident cases of diabetes during mean 4.7 year follow up 1)IFG alone- 32%(n=108) 2)HbA 1c alone- 9%(n=30) 3)Both- 46%(n=154)

10. Results  Patients progressing to diabetes after 5 years 1)IFG- 9%(108/1270 cases) 2)HbA 1c alone-7%(30/412 cases) 3)Both-38%(154/410 cases)

11. Results

12. Statistics Hazard Ratios compared with normoglycaemic individuals 1)IFG alone: 6.16(95%CI 4.33-8.77) 2)HbA1c alone: 6.00(95%CI 3.76-9.56) 3)Both: 31.9(95%CI 22.6-45.0)

13. Conclusion  Diagnosis of prediabetes by both HbA 1c and impaired fasting glucose ADA criteria resulted in increased risk of progression to diabetes.

14. Comment  By determining the likelihood of a patient with prediabetes progressing to diabetes, one can provide early intervention such as lifestyle modifications for control and possibly prevention.