Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study.

Mohsin Azam,Khalida Ismail,Lindsey Marwood,Sobha Sivaprasad,Stephanie Anne Amiel,Tyrrell Evans,Kirsty Winkley

doi:10.1155/2015/587673

Mohsin Azam, Khalida Ismail + Show 5 more

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https://doi.org/10.1155/2015/587673

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Abstract

Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes.

Highlights

The use of plasma glucose, measured after fasting and a standardised oral glucose load, for the diagnosis of type 2 diabetes (T2DM) has long been considered inconvenient [1]
The aims of this study were to examine the proportion of participants in the South London Diabetes (SOUL-D) cohort that were diagnosed with HbA1c < 48 mmol/mol (6.5%) before the new guidelines were introduced; determine whether these participants were significantly different from participants with higher HbA1c at diagnosis in their demography and diabetes complications; and investigate the criteria used to diagnose diabetes in patients with HbA1c < 48 mmol/mol (6.5%)
Of 1805 participants recruited into SOUL-D, this analysis was restricted to 1715 participants diagnosed before May 2012 (Figure 1)

Summary

Introduction

The use of plasma glucose, measured after fasting and a standardised oral glucose load, for the diagnosis of type 2 diabetes (T2DM) has long been considered inconvenient [1]. Glycated haemoglobin (HbA1c), formed in a nonenzymatic reaction between glucose and haemoglobin and reflecting a 2-3month average of plasma glucose concentrations in a single random sample [2], was considered as an alternative diagnostic tool for T2DM by an International Expert Committee in 2009 [1]. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes

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