Derivation and validation of an HbA1c optimal cutoff for diagnosing prediabetes in a South African mixed ancestry population

Zemlin, Annalise E; Matsha, Tandi E.; Kengne, André Pascal; Erasmus, Rajiv T

doi:10.1016/j.cca.2015.06.019

Cited by 15 publications

(11 citation statements)

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“…The present study is among the first to examine the performance of HbA1c as a diagnostic test for dysglycaemia or diabetes in a sub-Saharan African population living with HIV infection. Our key findings are the following: 1) HbA1c had an acceptable-to-good discriminatory ability to detect prevalent dysglycaemia (impaired fasting glycaemia, and/or impaired glucose tolerance) and screen-detected diabetes; 2) The study-specific optimal HbA1c cut-point to detect the presence of dysglycaemia was not appreciably different from the advocated cut-point by the ADA and IDF, while the optimal cut-point to detect screen-detected diabetes was lower than that recommended by the two organisations, but in line with previous studies in the general population in Africa [5, 13]; 3) Replacing FPG-based with HbA1c-predicted dysglycaemia in the JIS MS criteria led to marginally higher prevalence estimates, with generally good agreement between the original JIS and the modified criteria.…”

Section: Discussionsupporting

confidence: 82%

“…Some studies have suggested that low-grade haemolysis might contribute to lower HbA1c value at a given glucose level in HIV-infected patients than HIV-uninfected individuals [6,17]. Despite the above, the derived cut-points in our study appear consistent with those obtained in the local general population [5,13]. This suggests that the factors that influence HbA1c values in African populations are unlikely to differ by HIV status.…”

Section: Discussionsupporting

confidence: 76%

“…For the detection of dysglycaemia, the derived HbA1c cut-point of 5.75% (39.3 mmol/mol) is similar to that found in mixed-ancestry South Africans [13] and not appreciably different from the 5.7% (39 mmol/mol) recommended by the ADA/IDF. It should be understood that the present and previous studies in South Africa tend to agree more on HbA1c-based diagnosis for dysglycaemia than diabetes.…”

Section: Discussionsupporting

confidence: 58%

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Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans

et al. 2019

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BackgroundGlycated haemoglobin (HbA1c) test has been increasingly promoted as an alternative to fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) to diagnose dysglycaemia but its performance in HIV-infected Africans has yet to be established. This study aimed to assess the diagnostic accuracy of HbA1c for dysglycaemia including FPG-defined and OGTT-defined dysglycaemia, and OGTT-defined diabetes in HIV-infected Africans, and the effect of HbA1c-predicted dysglycaemia on Joint Interim Statement (JIS)-based prevalent metabolic syndrome (MS).MethodsA cross-sectional study included HIV-positive patients recruited across public healthcare facilities in the Western Cape. The recommended HbA1c cut-points were tested alongside the optimal cut-points obtained from receiver operating characteristic curve analyses, while the agreement between the MS criteria were assessed using kappa statistic.Results748 participants (157 men), median age 38 years, 93% on anti-retroviral drugs were included. The optimal HbA1c cut-points of 5.75% (39.3 mmol/mol) showed 54% sensitivity, 84% specificity for FPG-defined dysglycaemia, and 52% sensitivity, 85% specificity for OGTT-defined dysglycaemia. The HbA1c value of 5.85% (40.4 mmol/mol) (63% sensitivity, 99% specificity) was optimal for diabetes. The internationally advocated cut-point of 6.5% (48 mmol/mol) had 37% sensitivity and 99% specificity for diabetes, while HbA1c ≥5.7% (≥39 mmol/mol) yielded similar performance with the study-specific cut-point for any dysglycaemia. MS prevalence by the JIS criteria (28.2%) increased to 29.7% when using HbA1c ≥5.75% (≥39.3 mmol/mol) and to 32.9% with HbA1c ≥5.7% (≥39 mmol/mol); agreement between the original and modified criteria was generally good.ConclusionsThis study agrees with the internationally recommended HbA1c cut-point for detecting dysglycaemia, but not for diabetes in HIV-infected Africans. In line with previous studies in general African populations, our findings suggest that similar factors interfere with HbA1c values regardless of HIV infection status. Replacing FPG-based with HbA1c-predicted dysglycaemia in the JIS criteria to diagnose MS is feasible in HIV-infected Africans.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 58%

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Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans

et al. 2019

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“…We excluded 89 articles which were duplicate studies (n=1); performed before the year 2000 (n=9); had absence of full text or lack of sufficient data for extraction (n=22); had the presence of known diabetes, pre-diabetes or CVD (n=44); or target population whose subjects reported family history of diabetes, pre-diabetes or elevated BMI (n=13). Finally, we included 38 studies from 33 articles in the present systematic review 27–59…”

Section: Resultsmentioning

confidence: 99%

Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review

et al. 2022

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ObjectivesTo perform a systematic review on the characteristics of participants who attended screening programmes with blood glucose tests, lipid profiles or a combination of them, respectively.DesignSystematic review following the Meta-analysis Of Observational Studies in Epidemiology checklist.Data sourcesPubMed and Medline databases for English literature from 1 January 2000 to 1 April 2020.Eligibility criteriaOriginal observational studies that reported baseline characteristics of apparently healthy adult participants screening for diabetes and lipid disorders were included in this review.Data extractionWe examined their sociodemographic characteristics, including age, gender, body mass index (BMI) and lifestyle habits. The quality of the included articles was evaluated by the Appraisal of Cross-sectional Studies.ResultsA total of 33 articles involving 38 studies in 22 countries were included and analysed in this systematic review. Overall, there was a higher participation rate among subjects who were female in all screening modalities (female vs male: 46.6%–63.9% vs 36.1%–53.4% for diabetes screening; 48.8%–58.4% vs 41.6%–51.2% for lipid screening; and 36.4%–76.8% vs 23.2%–63.6% for screening offering both). Compared with the BMI standard from the WHO, participants in lipid screening had lower BMI (male: 23.8 kg/m2 vs 24.2 kg/m2, p<0.01; female: 22.3 kg/m2 vs 23.6 kg/m2, p<0.01). Furthermore, it is less likely for individuals of lower socioeconomic status to participate in diabetes or lipid screening in developed areas.ConclusionsWe identified that individuals from lower socioeconomic groups were less likely to take up programmes for diabetes and/or lipid screening in developed areas. These populations are also likely to be at higher risk of non-communicable diseases. Future studies should investigate the barriers and facilitators of screening among non-participants, where targeted interventions to enhance their screening uptake are warranted.

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“…Gleiches gilt für Bevölkerungsgruppen aus Subsahara-Afrika im Vergleich zu europäischen Bevölkerungen [27][28][29]. Bei Erwachsenen in Südafrika sind Sensitivität und Spezifität von HbA 1c zur Detektion eines Prädiabetes denkbar schlecht [30], sodass ein HbA 1c -Wert ≥ 6,0 % als neuer diagnostischer Grenzwert für diese Bevölkerungsgruppe vorgeschlagen wird [31].…”

Section: Besonderheiten In Der Diagnostikunclassified

Diabetes und Migration

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Aydınkoç-Tuzcu

Berger

et al. 2021

Diabetologie und Stoffwechsel

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Derivation and validation of an HbA1c optimal cutoff for diagnosing prediabetes in a South African mixed ancestry population

Cited by 15 publications

References 32 publications

Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans

Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans

Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review

Diabetes und Migration

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