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June 7, 2026Diabetes

Age 75+ and Black race linked to ~5-fold more HbA1c-only prediabetes, suggesting single tests miss dysglycemia.

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Why the study?

Prediabetes classification varies by test, shaping risk profiling and equity monitoring.

Population

11,091 adults aged 18+ without diabetes or pregnancy in NHANES 2005-2016

Comparison

HbA1c-only, FPG-only, OGTT-only, and concordant prediabetes vs normoglycemia

Design

Cross-sectional survey analysis

Key result

Age 75+ and non-Hispanic Black race/ethnicity were strongly associated with HbA1c-only prediabetes (aRRR 5.23 and 4.30, respectively), indicating reliance on a single test may miss dysglycemia.

Authors

RFR.M. FraserRWR J WalkerJCJENNIFER A. CAMPBELL

Discussion

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Overview

HbA1c-only screening may miss dysglycemia in older and Black adults; hypothesis-generating for equitable multi-test strategies.

Key Points

  • This research evaluates the prevalence of prediabetes classifications and their demographics according to different tests.
  • Analyzed NHANES 2005-2016 data on adults aged 18+, excluding pregnancy and diabetes.
  • Identified prediabetes phenotypes based on HbA1c, FPG, and OGTT results.
  • Utilized multinomial logistic regression to assess risk factors for different phenotypes.
  • 47.2% had normoglycemia, 6.8% HbA1c-only, 21.7% FPG-only, 3.7% OGTT-only, 20.7% concordant.
  • Age 75+ had the highest odds for HbA1c-only (aRRR 5.23) and OGTT-only (7.73) prediabetes.
  • Non-Hispanic Black individuals exhibited higher risks of HbA1c-only (aRRR 4.30) and concordant prediabetes (1.67).

Study Design

Type

Cross-Sectional (n=11,091)

Multicenter

Yes

Structured PICO

P
Population
11,091 nonpregnant U.S. adults aged 18 and older without diagnosed diabetes from NHANES 2005-2016.
E
Exposure
Prediabetes screening using HbA1c, fasting plasma glucose (FPG), and two-hour oral glucose tolerance test (OGTT)
C
Comparator
Normoglycemia
O
Outcome
National prevalence of prediabetes phenotypes (HbA1c-only, FPG-only, OGTT-only, or concordant) and correlates of phenotype membership

Main Result

Relative Risk: 5.23 (95% CI 2.98–9.18)

Discordant prediabetes phenotypes are common and patterned by age and race/ethnicity, suggesting that reliance on a single screening test may miss substantial dysglycemia and exacerbate health inequities.

Cite This Study

Fraser et al. (2026) conducted a cross-sectional in Prediabetes (n=11,091). Age 75+ years vs. Age 18-54 years was evaluated on HbA1c-only prediabetes (aRRR 5.23, 95% CI 2.98-9.18). Age 75+ and non-Hispanic Black race/ethnicity were strongly associated with HbA1c-only prediabetes (aRRR 5.23 and 4.30, respectively), indicating reliance on a single test may miss dysglycemia.

synapsesocial.com/papers/6a250c3b7def13d035e1c38ehttps://doi.org/10.2337/db26-2241-p
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