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Diabetes Res Clin Pract. 2019 Jul;153:93-102. doi: 10.1016/j.diabres.2019.05.026. Epub 2019 May 28.

Isolated HbA1c identifies a different subgroup of individuals with type 2 diabetes compared to fasting or post-challenge glucose in Asian Indians: The CARRS and MASALA studies.

Author information

1
Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N, Emory University, Atlanta, GA, USA. Electronic address: ugujral@emory.edu.
2
Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India; London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom. Electronic address: dprabhakaran@ccdcindia.org.
3
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
4
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 6th Floor, Chicago, IL, USA. Electronic address: Namratha.Kandula@nm.org.
5
Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India. Electronic address: dimple.kondal@phfi.org.
6
Department of Medicine, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Courtyard at Given S269, Burlington, VT, USA. Electronic address: neil.zakai@uvm.edu.
7
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India. Electronic address: dranjana@drmohans.com.
8
Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India. Electronic address: garima@ccdcindia.org.
9
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases, Prevention & Control, ICMR Centre for Advanced Research on Diabetes, Chennai, India. Electronic address: drmohans@diabetes.ind.in.
10
Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Room 7040 N, Emory University, Atlanta, GA, USA; Department of Medicine, School of Medicine, 201 Dowman Drive Emory University, Atlanta, GA, USA. Electronic address: knaraya@emory.edu.
11
Public Health Foundation of India, Unit No. 316 Situated on 3rd Floor, Rectangle-1 Building, Plot No. D-4, District Centre Saket, New Delhi, India; Department of Endocrinology and Metabolism, All Indian Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
12
Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Alka.Kanaya@ucsf.edu.

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.

KEYWORDS:

Diagnostic criteria; HbA1c; Type 2 diabetes

PMID:
31150721
PMCID:
PMC6635041
[Available on 2020-07-01]
DOI:
10.1016/j.diabres.2019.05.026

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