Sensibilidad y especificidad de la hemoglobina glicosilada como prueba diagnóstica de diabetes y prediabetes: revisión sistemática.

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) and prediabetes are highly prevalent public health problems in Latin America. Early detection is essential to prevent complications. Glycated hemoglobin (HbA1c) has been proposed as a diagnostic alternative to fasting plasma (FPG) and oral tolerance test (OGTT), although doubts remain about its sensitivity and specificity. Objective: To determine the sensitivity and specificity of HbA1c as a diagnostic test for diabetes and prediabetes in adults compared with traditional methods. Methodology: Systematic review in accordance with PRISMA 2020. Eligibility: observational, cohort, cross-sectional studies, and systematic reviews published from 2015 to 2025 in adolescents and adults (≥12 years). Children under 12 years of age, pregnant women, and patients with conditions that alter HbA1c were excluded. Risk of bias: assessed using QUADAS-2 and the NHLBI scale. Synthesis of results: comparative narrative analysis of sensitivity, specificity, LR+, and LR−. Results: Fifteen studies were included. The sensitivity of HbA1c ranged from 39% to 97.6% and specificity from 52% to 99%. The cutoff point ≥6.5% showed high specificity but low sensitivity; values between 5.9% and 6.3% improved sensitivity without significant loss of specificity. Discussion and Limitations: HbA1c is practical and specific, but its low sensitivity limits its use in isolation. Publication and language biases and methodological heterogeneity were identified. Conclusions: Adjusting cut-off points or combining HbA1c with FPG or OGTT improves detection in different clinical settings. Keywords: glycated hemoglobin, sensitivity, specificity, diabetes, prediabetes