Detection of diabetes and prediabetes using glycosylated hemoglobin in Chinese adults living in Shanghai: A prospective analysis

Abstract

BackgroundThis study aimed to evaluate the discriminative abilities of glycosylated hemoglobin (HbA1c) and to examine the optimal HbA1c cutoff values for diabetes and prediabetes in Chinese adults.MethodsData of a population‐based cohort of Chinese adults aged ≥40 years living in Jiading District in Shanghai were used. At baseline, 9389 and 7241 participants were included to identify the optimal HbA1c cutoff values for diabetes and prediabetes, respectively using the 1999 World Health Organization criteria as reference. In addition, the follow‐up data on incident diabetes of 4538 participants were used to determine the HbA1c cutoff value for prediabetes using the development of diabetes as reference. The discriminative abilities of HbA1c were evaluated using receiver operating characteristic (ROC) curves, and the optimal cutoff values were determined by Youden's index.ResultsThe areas under the ROC curves were 0.849 for diabetes, 0.614 for prediabetes using baseline data, and 0.648 for prediabetes using follow‐up data. An HbA1c cutoff value of 6.0% had the largest Youden's index to diagnose diabetes with a sensitivity of 70.2% and a specificity of 87.4%. An HbA1c cutoff value of 5.6% was indicated for prediabetes using both baseline and follow‐up data. However, the sensitivity and specificity were both low (55.4% and 61.1% using an oral glucose tolerance test as reference, 64.6% and 57.1% using incident diabetes as reference).ConclusionsAn HbA1c value ≥6.0% could be used to detect diabetes in Chinese adults aged ≥40 years. However, although an HbA1c value of 5.6% to 5.9% was indicated in this study, the overall discrimination of HbA1c for prediabetes was poor.

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

“… 54 However, Wang et al reported that around 64.6% of the individuals had an educational level at higher school or above in Shanghai. 47 For occupational status, Belfki et al indicated more than half (56.6%) of the participants were retired or had no current jobs. 54 The corresponding proportion was only 24.2% in Cuong et al ’s study.…”

“…Four studies stated the participants’ alcohol consumption; one reported a higher rate (79.8%), 45 compared with that reported in two studies (10.5%–13.64%). 47 52 Among the five studies which included physical activity, three of them reported that more than half of the participants performed adequate physical activity (60.5%–71.2%) 29 47 58 ( table 3 ).…”

“…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…”

“…The studies that presented the characteristics of screening participants in programmes that offered screening for both diabetes and lipid profiles were listed in table 1. Fourteen of these papers adopted FPG to evaluate blood glucose 27 30 31 35 37 38 45 47 49 50 52 54 56 58. Ten studies used HbA1c,28 29 35 38 42 47 49 50 52 58 nine studies used OGTT,28 29 31 38 47 49 50 52 59 while five of the included studies offered all three tests 38 47 49 50 52.…”

The multifactorial burden of Type 2 Diabetes mellitus: a study from clinical settings of University Hospital, Karachi, Pakistan

“…Questions for formative assessments, demographic background, health status, dietary habits and participant's lifestyle preferences were extracted from Michigan Diabetes care profile tests 19 . Study subjects were escorted to the diagnostic laboratory for their hemoglobin A1c (HbA1C), and a fasting serum insulin test was performed according to a standard protocol with cut-off values specified by the World Health Organization (WHO) 20 . BMI was recorded for each participant.…”