Abstract
Aims: Guidelines recommend hemoglobin A1c (HbA1c) as a diagnostic test for type 2 diabetes, but its accuracy may differ in certain ethnic groups. Methods: The prevalence of type 2 diabetes by HbA1c, fasting glucose, and 2 h glucose was compared in 3016 participants from Chennai and Delhi, India from the CARRS-2 Study to 757 Indians in the U.S. from the MASALA Study. Type 2 diabetes was defined as fasting glucose ≥ 7.0 mmol/L, 2-h glucose ≥ 11.1 mmol/L, or HbA1c ≥ 6.5%. Isolated HbA1c diabetes was defined as HbA1c ≥ 6.5% with fasting glucose < 7.0 mmol/L and 2 h glucose < 11.1 mmol/L. Results: The age, sex, and BMI adjusted prevalence of diabetes by isolated HbA1c was 2.9% (95% CI: 2.2–4.0), 3.1% (95% CI: 2.3–4.1), and 0.8% (95% CI: 0.4–1.8) in CARRS-Chennai, CARRS-Delhi, and MASALA, respectively. The proportion of diabetes diagnosed by isolated HbA1c was 19.4%, 26.8%, and 10.8% in CARRS-Chennai, CARRS-Delhi, and MASALA respectively. In CARRS-2, individuals with type 2 diabetes by isolated HbA1c milder cardio-metabolic risk than those diagnosed by fasting or 2-h measures. Conclusions: In Asian Indians, the use of HbA1c for type 2 diabetes diagnosis could result in a higher prevalence. HbA1c may identify a subset of individuals with milder glucose intolerance.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 93-102 |
| Number of pages | 10 |
| Journal | Diabetes Research and Clinical Practice |
| Volume | 153 |
| DOIs | |
| State | Published - Jul 2019 |
Funding
The CARRS Study was funded in part by the National Heart, Lung, and Blood Institute ( NHLBI ), National Institutes of Health ( NIH ), Department of Health and Human Services , under Contract No. HHSN268200900026C , and the United Health Group, Minneapolis, MN, USA., KMV Narayan was funded in part by the National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under Award Number P30DK111024 . The MASALA study was supported by the NIH grant numbers R01HL093009 and K24HL112827 . Data collection at UCSF was also supported by UCSF-CTSI grant number UL1RR024131 . Author Contributions: U.P.G. analyzed data, wrote the manuscript, drafted tables and figures, and revised the manuscript and approved the final manuscript for submission. D.P. N.T. V.M. and R.M.A. contributed to concept, design, and interpretation of the data, reviewed and revised the manuscript, and approved the final manuscript for submission. R.P. M.D. GR, and D.K. oversaw the CARRS research operations and contributed to the design, and data collection of the CARRS study. N.R.K contributed to the concept, design, discussion and interpretation of the data and reviewed and revised the manuscript, and approved the final manuscript for submission. K.M.V.N. contributed to concept, design, analysis, and interpretation of the data, reviewed and revised the manuscript, and approved the final manuscript for submission. N.A.Z. contributed to the discussion and interpretation of the data, reviewed and revised the manuscript, and approved the final manuscript for submission. A.M.K. obtained the funding for the MASALA study, collected the data, contributed to concept, design, analysis, discussion, and interpretation of the data, and reviewed and revised the manuscript, and approved the final manuscript for submission. U.P.G. is the guarantor of this work and has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors have no conflicts of interest. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. The CARRS Study was funded in part by the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract No. HHSN268200900026C, and the United Health Group, Minneapolis, MN, USA. KMV Narayan was funded in part by the National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under Award Number P30DK111024. The MASALA study was supported by the NIH grant numbers R01HL093009 and K24HL112827. Data collection at UCSF was also supported by UCSF-CTSI grant number UL1RR024131. The funding sources were not involved in the study design, collection, analysis, interpretation of data, writing the manuscript, or decision to submit the manuscript for funding.
Keywords
- Diagnostic criteria
- HbA1c
- Type 2 diabetes
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Endocrinology
