Plasma glucose and hemoglobin A1c for the detection of diabetes in Chinese adults

Abstract

Background The aim of the present study was to evaluate the performance of plasma glucose (PG) and HbA1c for the detection of diabetes in the general population in China. Methods A cross‐sectional analysis was conducted in a nationally representative sample of 98 658 Chinese adults aged ≥18 years. Fasting plasma glucose and HbA1c levels were measured in all participants after at least a 10‐h overnight fast. An oral glucose tolerance test (OGTT) was conducted among participants without a self‐reported history of diagnosed diabetes. Results An HbA1c ≥6.5% could identify 4.57% of Chinese adults as having newly detected diabetes, followed by fasting PG (FPG) and 2‐h PG at 4.52% and 3.50%, respectively. Approximately 1.95% of the total population was detected by HbA1c but not by FPG or 2‐h PG. However, FPG plus HbA1c could identify most (85.2%) diabetic individuals identified by any of the three tests (i.e. FPG, 2‐h PG, and HbA1c). Levels of most cardiovascular risk factors, such as body mass index, waist circumference, and cholesterol, were higher in diabetes detected by HbA1c alone than in diabetes identified by the OGTT. Conclusions Although HbA1c ≥6.5% has been recommended by the American Diabetes Association as one of the diagnostic tests for diabetes, caution should be used to avoid potential overdiagnosis when interpreting diabetes identified by elevated HbA1c alone.

Prevalence, Awareness, Treatment and Control of Diabetes Mellitus—A Population Based Study in Shanghai, China

“…The newest national cross-sectional survey of diabetes in China has found that the combination of FPG and HbA1c could identify the diabetes of the most diabetic individuals (approximately 85%) identified by any of the three tests ( i.e. , FPG, OGTT, and HbA1c) [ 28 ]. However, these results have already adequately revealed that diabetes has become a major public health problem in the China; the prevention and control of diabetes need improvement, even in economically-advanced areas with much better medical and health service facilities and conditions.…”

Hemoglobin A1c and diagnosis of diabetes

“…Approximately 16.8% of all cases of diabetes were detected by HbA1c alone, but not by FPG or 2‐h PPG. Levels of most cardiovascular risk factors, such as BMI, waist circumference, and cholesterol, were higher in diabetes identified by HbA1c alone than in diabetes diagnosed using glucose …”

“…For the three glycemic indices of HbA1c, FPG, and 2‐h post‐load plasma glucose (PPG), each misses cases of diabetes identified by another. Results from a cross‐sectional survey conducted in a nationally representative sample of 98 658 Chinese adults demonstrated that HbA1c ≥6.5% could identify 4.57% of Chinese adults as having newly diagnosed diabetes, followed by FPG and 2‐h PPG at 4.52% and 3.50%, respectively . The overlap of the three glycemic indices in diagnosing diabetes was modest.…”

“…Results from a crosssectional survey conducted in a nationally representative sample of 98 658 Chinese adults demonstrated that HbA1c ≥6.5% could identify 4.57% of Chinese adults as having newly diagnosed diabetes, followed by FPG and 2-h PPG at 4.52% and 3.50%, respectively. 78 The overlap of the three glycemic indices in diagnosing diabetes was modest. Only 13.0% of all cases of diabetes were diagnosed by all three indices.…”

“…Levels of most cardiovascular risk factors, such as BMI, waist circumference, and cholesterol, were higher in diabetes identified by HbA1c alone than in diabetes diagnosed using glucose. 78 Several studies have compared the diagnostic values of HbA1c and glucose on clinical outcomes. In the Atherosclerosis Risk in Communities (ARIC) study, the prognostic value of HbA1c and fasting glucose for identifying adults at risk of diabetes or cardiovascular disease was examined in 11 092 US adults who did not have a history of diabetes or cardiovascular disease.…”