Abstract
American Diabetes Association (ADA) has officially endorsed glycosylated haemoglobin (HbA1c) as a diagnostic tool. The recommended cut-off for diagnosing diabetes is 6.5%. To compare use of HbA1c and fasting plasma glucose (FPG) to diagnose diabetes in an urban Sri Lankan community. This cross-sectional study is based on baseline data from a prospective study on non-communicable diseases in randomly selected individuals aged 35-64 years in a selected community. HbA1c was measured by National Glycohaemoglobin Standardization Program certified Bio Rad Variant HbA1c HPLC method. Diagnostic performance of HbA1c was evaluated in those without previous diabetes. Receiver Operating Characteristic Curve was used to identify optimum HbA1c threshold. We studied 2516 individuals with no previous history of diabetes. Of these 53.8% were women. Mean age was 52 ± 7.9 years. FPG was 7mmol/l in 245 (9.7%). HbA1c was 6.5% in 173 (6.9%). Concordance between FPG and HbA1c was 95% (both criteria positive: 5.8%; both criteria negative: 89.2%). Compared to FPG, HbA1c cut-off of 6.5% had specificity of 98.9% (95% CI 98.3-99.3) and sensitivity of 60% (95% CI 53.6-66.2). Positive and negative predictive values were 85% (95% CI 78.8-89.9) and 95.8% (95% CI 94.9-96.6), respectively. Compared to FPG, optimum HbA1c threshold for diagnosing diabetes was 5.9% (sensitivity: 84%; specificity: 88.8%; area under the curve: 0.91). In the study population, detection of diabetes with ADA recommended HbA1ccriterion was 29% less than with FPG criterion. Compared to FPG, HbA1c had high specificity but sensitivity was low. Further research is needed to refine the optimum HbA1c threshold in Sri Lankans.
Highlights
Introduction American DiabetesAssociation (ADA) has officially endorsed glycosylated haemoglobin (HbA1c) as a diagnostic tool
Glycosylated haemoglobin (HbA1c) is a well-established measure of glycaemic control in those diagnosed with diabetes but until recent years it had not been considered suitable as a diagnostic tool due to lack of standardization of laboratory procedure
In 2009, an International Expert Committee, with members appointed by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) and the International Diabetes Federation (IDF), recommended the use of (HbA1c) to diagnose diabetes [7]
Summary
Association (ADA) has officially endorsed glycosylated haemoglobin (HbA1c) as a diagnostic tool. Glycosylated haemoglobin (HbA1c) is a well-established measure of glycaemic control in those diagnosed with diabetes but until recent years it had not been considered suitable as a diagnostic tool due to lack of standardization of laboratory procedure. During the last decade many studies have suggested that HbA1c is a useful tool for diagnosing diabetes [5]. The following year ADA officially endorsed HbA1c as a diagnostic test and recommended the cut-off value of 6.5% for diagnosing diabetes [8]. The ADA highlighted that the diagnostic test should be performed using a method that is certified by the National Glycohaemoglobin Standardization Program (NGSP) and standardized or traceable to the Diabetes Control and Complications Trial reference assay
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
