Abstract
We investigated whether adding anthropometric measures to HbA1c would have stronger discriminative ability over HbA1c alone in detecting dysglycemia (diabetes and prediabetes) among Asian women trying to conceive. Among 971 Singaporean women, multiple regression models and area under receiver-operating characteristic (AUROC) curves were used to analyze associations of anthropometric (weight, height, waist/hip circumferences, 4-site skinfold thicknesses) and HbA1c z-scores with dysglycemia (fasting glucose ≥6.1 mmol/L with 2-hour glucose ≥7.8 mmol/l). The prevalence of dysglycemia was 10.9%. After adjusting for sociodemographic/medical history, BMI (Odds Ratio [OR] = 1.62 [95%CI 1.32–1.99]), waist-to-height ratio (OR = 1.74 [1.39–2.17]) and total skinfolds (OR = 2.02 [1.60–2.55]) showed the strongest associations with dysglycemia but none outperformed HbA1c (OR = 4.09 [2.81–5.94]). After adjustment for history, adding BMI, waist-to-height ratio and total skinfolds (anthropometry trio) as continuous variables to HbA1c (AUROC = 0.80 [95%CI 0.75–0.85]) performed similarly to HbA1c alone (AUROC = 0.79 [0.74–0.84]). However, using clinically-defined thresholds without considering history, as in common clinical practice, BMI ≥ 23 kg/m2 + HbA1c ≥ 5.7% (AUROC = 0.70 [0.64–0.75]) and anthropometry trio + HbA1c ≥ 5.7% (AUROC = 0.71 [0.65–0.76]) both outperformed HbA1c ≥ 5.7% alone (AUROC = 0.61 [0.57–0.65]). In a two-stage strategy, incorporating BMI ≥ 23 kg/m2 alongside HbA1c ≥ 5.7% into first-stage screening to identify high risk women for subsequent oral glucose tolerance testing improves dysglycemia detection in Asian women preconception.
Highlights
It was suggested that adult diabetes stemmed from their early life exposure to a hyperglycemic environment in utero[4]
HbA1c is a strong marker for future diabetes, but its sensitivity in detecting concurrent dysglycemia is relatively poor in some populations[10]
There is evidence suggesting that variation in the magnitude of association between obesity and diabetes depends on the type of anthropometry used to measure obesity[15]
Summary
It was suggested that adult diabetes stemmed from their early life exposure to a hyperglycemic environment in utero[4]. The use of HbA1c threshold of ≥5.7% as an indicator of individuals at risk of diabetes and pre-diabetes was determined from general populations of predominantly the middle-aged, diverse ethnicities, and both sexes[13,14], and is currently not adopted widely as a screening test in the preconception setting. We performed a cross-sectional analysis of baseline preconception data from a prospective cohort to examine the discriminative ability of various anthropometric measures and HbA1c to detect dysglycemia in Asian women. We hypothesized that adding anthropometry to HbA1c would have stronger discriminative ability over HbA1c alone in detecting concurrent dysglycemia This could have implications for the provision of preconception care by improving our ability to diagnose dysglycemia and optimize preconception health
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