Abstract
ObjectiveHbA1c has been introduced as a complementary diagnostic test for diabetes, but its impact on disease prevalence is unknown. This study evaluated the concordance between HbA1c and fasting plasma glucose (FPG) in the diagnosis of diabetes in the general population.Materials and methodsThe study was designed as a population based investigation, with participants being sampled from the Ho Chi Minh City, Vietnam. Blood samples were collected after overnight fasting and analyzed within 4 hours after collection. HbA1c was measured with high pressure liquid chromatography (Arkray Adams, Japan). FPG was measured by the hexokinase method (Advia Autoanalyzer; Bayer Diagnostics, Germany). Diabetes was defined as HbA1c ≥ 6.5% or FPG ≥ 7.0 mmol/L. Prediabetes was classified as HbA1c between 5.7% and 6.4%.ResultsThe study included 3523 individuals (2356 women) aged 30 years and above. Based on the HbA1c test, the prevalence of diabetes and prediabetes was 9.7% (95%CI, 8.7–10.7%; n = 342) and 34.6% (33.0–36.2; n = 1219), respectively. Based on the FPG test, the prevalence of diabetes and prediabetes was 6.3% (95%CI, 5.5–7.2%; n = 223) and 12.1% (11.1–13.2; n = 427). Among the 427 individuals identified by FPG as "pre-diabetes", 28.6% were classified as diabetes by HbA1c test. The weighted kappa statistic of concordance between HbA1c and FPG was 0.55, with most of the discordance being in the prediabetes group.ConclusionThese data indicate that there is a significant discordance in the diagnosis of diabetes between FPG and HbA1c measurements, and the discordance could have significant impact on clinical practice. FPG appears to underestimate the burden of undiagnosed diabetes.
Highlights
Type II diabetes and its associated morbidity and mortality are increasingly becoming a serious burden for society in developed as well as developing countries
Among the 427 individuals identified by fasting plasma glucose (FPG) as "pre-diabetes", 28.6% were classified as diabetes by HbA1c test
The weighted kappa statistic of concordance between HbA1c and FPG was 0.55, with most of the discordance being in the prediabetes group
Summary
Type II diabetes and its associated morbidity and mortality are increasingly becoming a serious burden for society in developed as well as developing countries. It is projected that between 2010 and 2030, the number of adults with diabetes will be increased by approximately 20% in developed countries and 69% in developing countries [1]. The Asia Pacific region has been identified as an epicenter of diabetes [2, 3], as the region has undergone rapid economic development accompanied by sedentary lifestyles and poor nutrition: all contributing to the increased risk of the disease. In China alone, the prevalence of diabetes has increased from 1% in 1980 to 10% in 2008 [4, 5]. Identification of high-risk individuals is considered the best strategy to contain the burden and costs of diabetes and its associated complications in the general population [9]
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