Hemoglobina Glicosilada Y Sindrome Metabolico

ORIGINAL ARTICLE

Endocrinology, Nutrition & Metabolism
http://dx.doi.org/10.3346/jkms.2012.27.9.1057 • J Korean Med Sci 2012; 27: 1057-1061

Usefulness of Glycated Hemoglobin as Diagnostic Criteria for
Metabolic Syndrome
Sang Hyun Park, Ji Sung Yoon,
Kyu Chang Won, and Hyoung Woo Lee
Department of Internal Medicine, Yeungnam
University College of Medicine, Daegu, Korea
Received: 27March 2012
Accepted: 26 June 2012
Address for Correspondence:
Ji Sung Yoon, MD
Department of Internal Medicine, Yeungnam University College
of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717,
Korea
Tel: +82.53-620-4049, Fax: +82.53-654-8386
E-mail: jsyoon9@ynu.ac.kr

The metabolic syndrome (MetS) is the clustering of cardiovascular risk factors and known
as a powerful predictor ofdiabetes and cardiovascular disease. Glycated hemoglobin
(HbA1c) is used as one of the diagnostic criteria for diabetes and category of increased risk
for diabetes. We examined the usefulness of HbA1c as a diagnostic tool for MetS and to
determine the cut-off value of HbA1c as a criterion for MetS, in non-diabetic Korean
subjects. We analyzed 7,307 participants (male: 4,181, 57%) in a medicalcheck-up
program, and applied the newly recommended guidelines of the International Diabetes
Federation for diagnosis of MetS. The mean HbA1c was 5.54% in all subjects and showed
no significant difference between genders. Using receiver-operating characteristic curve,
HbA1c value corresponding to the fasting plasma glucose value of 100 mg/dL was 5.65%
(sensitivity 52.3%, specificity 76.7%). Theprevalence of MetS was 8.5% according to the
IDF guideline and 10.9% according to HbA1c value of 5.7%, showing 69.5% agreement
rate. The detection rate of MetS increased to 25.7% using the HbA1c criterion of 5.7%
instead of fasting hyperglycemia. This study suggests that HbA1c might be used as a
diagnostic criterion for MetS and the appropriate cut-off value of HbA1c may be 5.65% in
thisKorean population.
Key Words: Metabolic Syndrome; Fasting Hyperglycemia; HbA1c

INTRODUCTION
The metabolic syndrome (MetS) is the clustering of closely related cardiovascular risk factors (1), such as obesity, dyslipidemia,
hypertension and hyperglycemia and is known as a powerful
predictor of diabetes and cardiovascular disease (CVD) (2, 3). It
was reported that number of MetS component wasrelated to
the severity of coronary atherosclerosis especially in non-diabetic patients (4). The underlying pathophysiology of MetS is
insulin resistance, but direct measurement of insulin sensitivity
is complex and not readily available. Instead, various anthropometric, hemodynamic, and biochemical parameters have been
used to diagnose MetS (5). Recently, a harmonizing definition
of MetS wasproposed in a joint statement by several organizations in 2009 (6). However, the fasting plasma glucose (FPG)
cut-off values for MetS and diabetes may be different between
populations. In a study involving middle-aged Koreans, it was
suggested that the risk of diabetes starts to increase at the FPG
level of below 6.1 mM/L (7).
Glycated hemoglobin (HbA1c) was proposed to be used as
one of thediagnostic criteria for diabetes and category of increased risk for diabetes including impaired glucose tolerance
(IGT) and impaired fasting glucose (IFG). They proposed HbA1c

value of 5.7% to 6.4% to be considered a category of increased
risk for diabetes (IRD) (8). Recently, it was reported that although
HbA1c criteria alone identified 42% fewer subjects with IRD than
does FPG criteria,about 20% more subjects could be detected by
including new HbA1c criteria in addition to FPG criteria among
Koreans. And they suggested that addition of new HBA1c criteria might be useful in detecting the subjects with IRD (9). HbA1c
represents both fasting and postprandial glycemic states and is
an index of mean blood glucose. Therefore, HbA1c has traditionally been used in monitoring the...