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June 7, 2026Diabetes

Weighted prevalence was 47.2% normoglycemia, 6.8% HbA1c-only, 21.7% FPG-only, 3.7% OGTT-only, and 20.7% concordant; Non-Hispanic Black adults had higher risk of HbA1c-only prediabetes (aRRR 4.30, 95% CI 2.61-7.08).

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Population

11,091 U.S. adults aged 18+ without diagnosed diabetes and not pregnant, from NHANES 2005-2016.

Comparison

Prediabetes screening using HbA1c, fasting… vs Normoglycemia

Design

Cross-sectional

Authors

RFR.M. FraserRWR J WalkerJCJENNIFER A. CAMPBELL

Discussion

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Overview

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.

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).

Structured PICO

P
Population
11,091 U.S. adults aged 18+ without diagnosed diabetes and not pregnant, from NHANES 2005-2016 (representing 182.9 million adults).
I
Intervention
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

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) studied this question.

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

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic Performance of HbA1c for Detecting OGTT-Diagnosed Diabetes in Obese Individuals with Suspected Prediabetes2026 · 1 citations
  2. 22225-P: Ethnic Disparities in the Prevalence and Risk Factors of Prediabetes and Diabetes in Australian Primary Care2026
  3. 3Contributions of 2‐h post‐load glucose, fasting blood glucose and glycosylated haemoglobin elevations to the prevalence of diabetes and pre‐diabetes in adults: A systematic analysis of global data2025
  4. 42221-P: Prediabetes Prevalence and Diabetes Incidence according to Different Prediabetes Definitions: Implications for Diabetes Prevention2026
  5. 51929-P: Assessing Glycemic Variability by Continuous Glucose Monitoring: Implications for Prediabetes Subtypes and Potential Cardiovascular Risk2026