{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T22:13:57Z","timestamp":1778364837762,"version":"3.51.4"},"reference-count":25,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":4587,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>The purpose of this study was to examine the prevalence and correlates of elevated A1C in a large, nationally representative sample of adults without diabetes in the U.S.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We analyzed data from 15,934 participants aged \u226520 years without diagnosed diabetes who had A1C measurements in the 1999\u20132006 National Health and Nutrition Examination Survey, a cross-sectional and nationally representative sample of the U.S. population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The overall prevalence of A1C &amp;gt;6% was 3.8%, corresponding to 7.1 million adults without diabetes in the U.S. population. Approximately 90% of these individuals had fasting glucose \u2265100 mg\/dl. Older age, male sex, non-Hispanic black race\/ethnicity, hypercholesterolemia, higher BMI, and lower attained education were significantly associated with having a higher A1C level even among individuals with normal fasting glucose (&amp;lt;100 mg\/dl) and after multivariable adjustment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>A single elevated A1C level (A1C &amp;gt;6%) is common in the general population of adults without a history of diabetes and is highly reliable for the detection of elevated fasting glucose. Nondiabetic adults with elevated A1C are likely to have impaired fasting glucose and an array of other risk factors for type 2 diabetes and cardiovascular disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc08-1699","type":"journal-article","created":{"date-parts":[[2009,2,7]],"date-time":"2009-02-07T04:46:30Z","timestamp":1233981990000},"page":"828-833","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":79,"title":["Elevated A1C in Adults Without a History of Diabetes in the U.S."],"prefix":"10.2337","volume":"32","author":[{"given":"Elizabeth","family":"Selvin","sequence":"first","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick L.","family":"Brancati","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1167","published-online":{"date-parts":[[2009,2,5]]},"reference":[{"key":"2022031220104660300_B1","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1111\/j.1525-1497.2004.40178.x","article-title":"Utility of hemoglobin A1c in predicting diabetes risk","volume":"19","author":"Edelman","year":"2004","journal-title":"J Gen Internal Med"},{"key":"2022031220104660300_B2","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.2337\/diacare.23.12.1770","article-title":"Combined use of fasting plasma glucose and HbA1c predicts the progression to diabetes in Chinese subjects","volume":"23","author":"Ko","year":"2000","journal-title":"Diabetes Care"},{"key":"2022031220104660300_B3","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.amjmed.2007.03.022","article-title":"Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women","volume":"120","author":"Pradhan","year":"2007","journal-title":"Am J Med"},{"key":"2022031220104660300_B4","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.2337\/dc05-2525","article-title":"Use of HbA1c in predicting progression to diabetes in french men and women: data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR)","volume":"29","author":"Droumaguet","year":"2006","journal-title":"Diabetes Care"},{"key":"2022031220104660300_B5","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.diabres.2007.01.024","article-title":"The combination of fasting plasma glucose and glycosylated hemoglobin predicts type 2 diabetes in Japanese workers","volume":"77","author":"Inoue","year":"2007","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031220104660300_B6","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1001\/archinte.164.19.2147","article-title":"Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? 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Survey Operations Manuals, Brochures, and Consent Documents: 1999-current NHANES. Available at http:\/\/www.cdc.gov\/nchs\/nhanes.htm [article online], 2007. Accessed 6 March 2009"},{"key":"2022031220104660300_B13","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.2337\/dc08-S055","article-title":"Diagnosis and classification of diabetes mellitus","volume":"31","author":"American Diabetes Association","year":"2008","journal-title":"Diabetes Care"},{"key":"2022031220104660300_B14","unstructured":"National Health and Nutrition Examination Survey 2005\u20132006. Documentation, Codebook, and Frequencies: glycohemoglobin [article online], 2008. Available from: http:\/\/www.cdc.gov\/NCHS\/data\/nhanes\/nhanes_05_06\/ghb_d.pdf. Accessed 6 March 2009"},{"key":"2022031220104660300_B15","unstructured":"National Health and Nutrition Examination Survey 2005\u20132006. 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