Evaluation of Glycated Hemoglobin (HbA1c) for Diagnosing Type 2 Diabetes and Prediabetes among Palestinian Arab Population

Abstract

The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes (≥ 126 mg/dL) and prediabetes (100–125 mg/dL). The area under the receiver operating characteristic curve (AUC) for HbA1c was 81.9% to diagnose diabetes and 63.9% for prediabetes. The agreement between HbA1c and diabetes as diagnosed by FPG was moderate (ĸ = 0.498) and low with prediabetes (ĸ = 0.142). The optimal cut-off value for HbA1c to diagnose diabetes was ≥ 6.3% (45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0% (72.8–87.3%), respectively. However, using cut-off value of ≥ 6.5% (48 mmol/mol) improved specificity. At this cut-off value, the sensitivity, specificity and the discriminant ability were 57.4% (44.9–69.0%), 97.1% (96.0–97.9%) and 77.3% (71.0–83.5%). For diagnosing prediabetes with HbA1c between 5.7–6.4% (39–46 mmol/mol), the sensitivity, specificity and the discriminant ability were 62.7% (57.1–67.9%), 56.3% (53.1–59.4%) and 59.5% (56.3–62.5%), respectively. HbA1c at cut-off value of ≥ 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5% and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c and FPG.

Underwater Treadmill Training, Glycemic Control, and Health-Related Fitness in Adults with Type 2 Diabetes

“…The degree of improvement in cardiorespiratory fitness noted in our study was also similar to the 8.6% increase in VO 2 max following a 16-week circuit resistance training program which employed gradual increments in intensity and duration and met current exercise guidelines for adults with type 2 diabetes (Kang et al, 2009). The increase in aerobic fitness in the current study was also similar to the average gain of 3.6 ml•kg -1 •min -1 seen in middle-aged obese adults who completed 3 months of underwater-or land-based treadmill walking (Greene et al, 2009).…”

“…In contrast, a nonsignificant decrease in RHR of 1 bpm was recorded in both postmenopausal women with type 2 diabetes who engaged in circuit resistance training for 12 weeks and older adults with type 2 diabetes who completed a 16-week resistance exercise training program (Castaneda et al, 2002;Kang et al, 2009). The extensive amount of cardiovascular exercise performed by participants during UTT, coupled with their relatively sedentary lifestyle, may partially account for the observed decrease in RHR measured in the current study.…”

Utility of glycosylated haemoglobin in diagnosing diabetes in an urban Sri Lankan community

“…Almost similar thresholds have been reported in Korea and India [16,17]. There are several other studies from China, USA, Bulgaria, Bangladesh, Malaysia, and in the Middle East which found that the optimum HbA1c thresholds were lower than the ADA cut-off [14,[19][20][21][22]29,30]. However, one study of the indigenous population in Australia reported an optimum cut-off of 7% [23].…”

Cross-sectional study of glycosylated haemoglobin in type 2 diabetes mellitus patients of South Indian origin

“…8,9,10,11 Major Asian studies of Ma H, Wan Nazaimoon WM, Hu Y, Bhowmik B etc suggested a range of 6.0 to 6.3% as the reliable value for HbA1c among Asian populations. 12,13,14,15,16 West Asian and Arab studies of Akram T and Hajat C on the other hand suggested a higher level of 6.3 to 6.4% 17,18 . Whereas previous Indian studies by Nair M and Ramachandran A reported a much lower cut off level of 5.8% and 6.05% respectively.…”