Advances in Health Sciences Research, volume 26

2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019)

Relationship Between Levels of Fasting

Blood Glucose and HbA1C in Prediabetes
Patients
Ria Amelia*, Danny Luhulima
Departemen of Medical Laboratory Technology, STIKes Mitra Keluarga, Bekasi
Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
[email protected], [email protected]

Abstract ---Prediabetes is a condition blood glucose Diabetes Association (ADA), Indonesian

levels are higher than normal but lower than Endocrinology Association (Perkeni), the criteria
diagnosis of diabetes mellitus. Parameters prediabetes diagnosis of diabetes can be confirmed if the
according to the American Diabetes Association 2017, condition of blood sugar during fasting is above
blood glucose levels ≥100 - <126 mg/dL in impaired
fasting glucose, ≥ 12 mg/dL in impaired glucose
126mg/dl and 2 hours after meals (2 hours post
tolerance and HbA1C level 5.7 - 6.4%. HbA1C test prandial) above 200mg/dl. Impaired Fasting
describe of the state blood glucose in the last 2-3 Glucose (IFG) condition if the fasting blood sugar
months. The study aimed to determine relationship of level is between 100-125mg/dl while Impaired
fasting blood glucose and HbA1C value in Glucose Tolerance (IGT) condition is impaired if
determining prediabetes. Methods of research is the fasting blood sugar is above 126 mg/dl while
descriptive, using secondary data. Data collection was the Impaired Glucose Tolerance (IGT) condition is
carried out during April to September 2018 at one of impaired if the fasting blood sugar is above 126
the private hospitals in East Bekasi. Total samples mg/dl but 2 hours after eating 140-200mg/dl. Both
inclusion factor were 92 samples. The Spearman test
results showed relationship is positive and weak (r =
IFG and IGT are also called prediabetes, which are
0.230) with α = 0.05 and the linear regression test line strong candidates for future diabetes. Prediabetes is
equation yields HbA1C value = 5,430+ 0.003 (blood a danger sign, a yellow light, a marker of diabetes
glucose value) + 0.005 (age) with R value 0.309 later, or a "candidate" for diabetes. Comparison of
between fasting blood glucose test and HbA1C values diabetes patients with prediabetes in Indonesia is 1:
in prediabetes. The results of this study indicate that 3 [4].
value of fasting blood glucose affects value of HbA1C.
The higher blood glucose is more Hb molecules that Indonesia was ranked third in the world with the
bind to sugar. number of prediabetes as many as 29 million
people beat China. Prediction in 2040 Indonesia
Keywords: prediabetes, blood glucose levels, HbA1C, will be ranked first number of prediabetes which is
glycated hemoglobin, fasting blood glucose
estimated to reach 36.8 million people. Laboratory
tests for the prediabetes of the recommended is
I. INTRODUCTION HbA1C test because these tests can be performed
both on IGT and TGT patient [5]. HbA1C is a
Diabetes mellitus is a metabolic disorder that has blood glucose test through measurement of
become a global problem. Based on data from hemoglobin A1C levels found in erythrocytes.
Riskesdas (2013) 5.7% of diabetics patient in HbA1C is hemoglobin that can bind to glucose
Indonesia, almost 73.7% or around 8,485,329 (glycohemoglobin) [6]. The HbA1C test describes
million were not diagnosed with diabetes. This can state of blood sugar in the last 2-3 months. Several
be considered dangerous because a late diagnosis recent studies recommend HbA1C test to diagnose
can cause many complications that occur in type 2 or screening for prediabetes as a comparison of the
diabetes mellitus [1]. Fasting blood glucose test examination of venous blood glucose tests [5, 7].
(hexokinase methode) uses venous blood is a gold The use of two different methods of testing blood
standard for diagnosis of diabetes mellitus type 2 glucose is recommended to confirm and establish a
and is often used in hospitals [2,3]. According to diagnosis of someone prediabetes or diabetes [5].
International Diabetes Federation (IDF), American HbA1C values for normal people are below 5.6%,

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 Advances in Health Sciences Research, volume 26

prediabetes is between 5.7 - 6.4%, diabetes is above Descriptive Analysis Descriptive and Test
6.5%[4]. Normality Data
In this study sample data included in the inclusion
II. MATERIALS AND METHODS criteria were 92 samples consisting of 43 men
(46.7%) and 49 female (53.3%). The age
The research method was descriptive observational distribution of 92 prediabetes samples obtained the
analytic and the sampling technique was cross - youngest sample age is 10 years old, the oldest is
sectional. Data was collected at the Clinical 81 years old and modus is 49 years as many as 6
Pathology Laboratory of East Bekasi Private people. The mean age of the sample is 50.65 (SD
Hospital. The data taken is secondary data that is 11.97) with normality distributed data using
included in the inclusion criteria, which has a Kolgomorov-Smirnov test showing a significant
HbA1C test result of 5.7 - 6.4%, does a fasting value of 0.2 above 0.05. Distribution of fasting
blood sugar test, there is no routine history of blood glucose test results obtained a median value
carrying out the HbA1C test and fasting blood of 100 mg/dL, the highest fasting blood glucose
sugar. Data was collected from April to September value obtained at 168 mg/dL and the lowest 71
2018. The data was processed using the SPSS mg/dL. Distribution of the HbA1C test results
program to test the description, normality, obtained a median value of 6.0%, the highest
spearman correlation test and regression with an HbA1C value obtained at 6.4% and the lowest at
error rate of 5% [8]. 5.2%. The results of the normality test using the
Kolgomorov-Smirnov test on fasting blood glucose
and HbA1C tests showed values below 0.05 which
means the data are not normally distributed. Table
III. RESULT 1. below draws the descriptive results of the data
obtained.

Table 1 Descriptive Results And Normality of Prediabetes Samples

Variabel Result
Total samples n = 92 samples
Sex Female = 49 (53.3%) Male = 43 (46.7%)
Age Youngest = 10 years Modus = 49 years Oldest = 81 years Mean = 50 years Kolgomorov-
(6.5%) (SD 11.97) Smirnov test
p>0.05
(normality)
Fasting blood Min = 71 mg/dL Max = 168 mg/dL Median= 100 mg/dL Kolgomorov-Smirnov test p<0.05 ( not
glucose levels normality)
HbA1C Min = 5.2 % Max = 6.4 % Median = 6.0 % Kolgomorov-Smirnov test p<0.05 ( not
normality)

Correlation and regression analysis of fasting examination of fasting blood glucose and
blood glucose levels and HbA1C HbA1C in patients with prediabetes means that
The results of fasting glucose test and HbA1C H0 was rejected. Spearman correlation value
showed abnormalities, so to determine the of 0.230 shows that the direction of the
relationship between the two variables used the positive correlation with the strength of the
spearman test. Spearman test results showed a correlation is weak. Table 2. presents the
significant relationship between the results of the Spearman correlation analysis.

Table.2 Spearman correlation test results between

fasting blood glucose and HbA1C in prediabetes at α = 0.05
Fasting blood glucose levels
HbA1C r 0.230
p 0.027
n 92

From the results of the Spearman test, it can independent variable. In this study the
proceed to the linear regression test to predict dependent variable is HbA1C and independent
the value of a dependent variable through the fasting blood glucose levels and age. The

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results of the linear regression test can be seen in table 3.

Tab le 3. Regression analysis of HbA1C with fasting blood glucose level and age in prediabetes
Variable R Adjusted R 2 Line equation P value
fasting blood 0.309 0.075 HbA1C= 5.430+ 0.003 (fasting blood glucose level)+ 0.005(age) 0.012
glucose level and
age

The relationship of HbA1C with fasting blood equation obtained is able to approach actual
glucose level in prediabetes showed a weak HbA1C test results. The adjusted R2 value obtained
relationship (R = 0.309) and positive patterned. is 0.075 or 7.5% meaning that equation obtained is
This means that the greater the value of fasting able to approach the HbA1C test results, the
blood glucose, the greater HbA1C too. The adjusted remaining 92.5% is explained by other variables
R2 value means how much value (percent) of the (residues).

IV. DISCUSSION
Based on table 1, the prediabetes sample suffered activities on social media such as food, fast food
more women (53.3%) than men (46.7%). Sex restaurants that tend to entice someone to try and
differences can affect factors of type 2 diabetes cause obesity. Prediabetes increases the risk of
mellitus such as differences in the type of sex becoming type 2 diabetes mellitus and
hormones in women and men, these differences cardiovascular disease. Early identification and
have a major influence on energy metabolism, body management of prediabetes diagnosis can reduce
composition, vascular function and inflammatory the incidence of diabetes and its complications [11].
response. Thus, endocrine imbalance can cause the Management of prediabetes screening or risk of
risk of prediabetes to type 2 diabetes mellitus, diabetes with asymptomatic symptoms such as
especially in women who have a greater risk of weight weighing in adolescents who are overweight
both biological factors and due to stress exposure. or obese (BMI 25kg/m2 or ≥23kg/m2 in Asian
Patients with prediabetes with conditions of Americans), routine blood glucose testing in
impaired glucose tolerance (IGT) are more someone 45 years old If the test shows normal,
experienced by women and prediabetes with repeat test for at least 3 years after the last blood
conditions of impaired fasting glucose (IFG) are glucose test. Prediabetes can also be associated
mostly experienced in men [9]. Prediabetes criteria with obesity (especially abdominal or visceral
according to The American Diabetes Association obesity), dyslipidemia with high triglycerides, low
2017 in Table 1. shows fasting glucose levels in HDL cholesterol and hypertension [12].
IGT patients> 126 mg / dL and IFG are between>
100 - <126 mg / dL. Based on this, the results of HbA1C test is specific glycated hemoglobin that is
this study indicate the average value of fasting formed due to addition of glucose to N-terminal
blood glucose in men is 100.97 mg / dL and in amino acid valine in α-hemoglobin chain. In this
women is 103.3 mg / dL. These results indicate study a weak relationship was found between
prediabetes criteria in men and women are in the fasting blood glucose yield and HbA1c. Despite
category of IFG. having a weak association HbA1C is still used as a
marker to diagnose prediabetes besides fasting
Prediabetes can be experienced everyone at any
age, especially in people with obesity and age 45 blood glucose testing. This is because concentration
years, in table 1 shows that most patients with of glycated hemoglobin (HbA1C) depends on the
prediabetes are 49 years old. prediabetes can be concentration of blood glucose and lifespan of a red
experienced by anyone at any age, especially in blood cell which is typically 120 days, which
people with obesity and over the age of 45 years, in means the relative proportion of HbA1C at any one
table 1 shows that most patients with prediabetes time depends on the mean circulating blood glucose
are 49 years old. Factors that can affect prediabetes level over that 3 month period [13]. HbA1C test
condition such as level of education, level of and fasting blood glucose results when used as a
opinion, place of residence, daily activities and basis for making adjustments to the treatment of
family history of diabetes [10]. The majority of pre-diabetes mellitus [14]. Use of HbA1C as a
factors that influence prediabetes are social screening marker has rapidly been adopted in
behavior factors. Nowadays people tend to share

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clinical practice by a growing number of countries useful in helping to diagnose prediabetes conditions
where it may provide an excellent cost efficient early for Indonesian society. Fasting blood glucose
approach to T2D screening providing it is shown to tests more applicable because the tools used are
have adequate sensitivity and specificity [15]. available almost every laboratory in Indonesia.
Indonesia ranks seventh with 10 million diabetics
and is predicted to increase to sixth with 16.2
V. CONCLUSION
million diabetics in 2040 by comparing type 2
There is a correlation between fasting blood
diabetes mellitus with prediabetes 1 : 3 [16].
glucose test and HbA1C results in patients with
Diagnostic techniques can effective, efficient and prediabetes with a weak (R = 0.309) and positive
accurate urgently needed to diagnose prediabetes so relationship.
that it does not develop into type 2 diabetes mellitus
in Indonesia as develop country. However, HbA1C ACKNOWLEDGMENTS
tets expensive costs so that other testing methods Thanks to STIKes Mitra Keluarga for funding this
that cheaper and can be converted to HbA1C are research and the hospital for granting permission so
needed. The results of this study are expected to be that research can be carried out.

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