Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey - PubMed (original) (raw)

Multicenter Study

Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey

Yuqian Bao et al. BMJ. 2010.

Abstract

Objectives: To evaluate haemoglobin A1c (HbA(1c)) in diagnosing diabetes and identify the optimal HbA(1c) threshold to be used in Chinese adults.

Design: Multistage stratified cross sectional epidemiological survey.

Setting: Shanghai, China, 2007-8.

Participants: 4886 Chinese adults over 20 years of age with no history of diabetes.

Main outcome measures: Performance of HbA(1c) at increasing thresholds for diagnosing diabetes.

Results: The area under the receiver operating characteristics curve for detecting undiagnosed diabetes was 0.856 (95% confidence interval 0.828 to 0.883) for HbA(1c) alone and 0.920 (0.900 to 0.941) for fasting plasma glucose alone. Very high specificity (96.1%, 95% confidence interval 95.5% to 96.7%) was achieved at an HbA(1c) threshold of 6.3% (2 SD above the normal mean). Moreover, the corresponding sensitivity was 62.8% (57.1% to 68.3%), which was equivalent to that of a fasting plasma glucose threshold of 7.0 mmol/l (57.5%, 51.7% to 63.1%) in detecting undiagnosed diabetes. In participants at high risk of diabetes, the HbA(1c) threshold of 6.3% showed significantly higher sensitivity (66.9%, 61.0% to 72.5%) than both fasting plasma glucose >or=7.0 mmol/l (54.4%, 48.3% to 60.4%) and HbA(1c) >or=6.5% (53.7%, 47.6% to 59.7%) (P<0.01).

Conclusions: An HbA(1c) threshold of 6.3% was highly specific for detecting undiagnosed diabetes in Chinese adults and had sensitivity similar to that of using a fasting plasma glucose threshold of 7.0 mmol/l. This optimal HbA(1c) threshold may be suitable as a diagnostic criterion for diabetes in Chinese adults when fasting plasma glucose and oral glucose tolerance tests are not available.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Flow diagram of recruitment of participants

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Fig 2 Receiver operating characteristics curve of HbA1c for detecting diabetes at each possible HbA1c threshold. Area under curve=0.856 (95% CI 0.828 to 0.883)

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References

    1. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008;93:2447-53. - PubMed
    1. Jia WP, Pang C, Chen L, Bao YQ, Lu JX, Lu HJ, et al. Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Diabetologia 2007;50:286-92. - PubMed
    1. World Health Organization. The world health report: primary health care—now more than ever. WHO, 2008.
    1. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus. WHO, 1999.
    1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26(suppl 1):S5-20. - PubMed

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