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HbA 1c screening for undiagnosed diabetes in New Zealand
Author(s) -
Ellison Tracy L.,
Elliott Robert,
Moyes Simon A.
Publication year - 2004
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.486
Subject(s) - medicine , diabetes mellitus , population , ethnic origin , ethnic group , fasting glucose , demography , endocrinology , insulin resistance , environmental health , sociology , anthropology
Objectives To describe a screening programme to detect undiagnosed diabetes in high‐risk ethnic groups in New Zealand and determine the specificity and sensitivity of HbA 1c to detect fasting hyperglycaemia. Research design and methods HbA 1c was offered to subjects over 20 years of age participating in a screening programme for hepatitis B that was targeted at non‐European populations. Two hundred and forty‐four predominantly Maori subjects, with HbA 1c levels 5 to 7.9% and who were not known to have diabetes, were tested with an oral glucose tolerance test. Comparison was made with fasting and 2‐h samples. Results Fifty thousand eight hundred and nineteen subjects were screened using HbA 1c . 12% had HbA 1c levels of 6.1% or more, and in 4% of the population HbA 1c was 7.1% or more. Maori, Pacific Island people, and Indians had particularly high rates of elevated HbA 1c . HbA 1c levels of 6.1% and greater were 94% sensitive and 77% specific in detecting the 32 subjects who had a fasting glucose of 7.0 mmol/L or more, and 90% sensitive and 73% specific for 20 subjects with a 2‐h glucose of 11.1 mmol/L or more. Conclusions Rates of elevated HbA 1c levels in non‐Europeans in New Zealand are very high, particularly in Maori, Pacific Island Peoples', and Indians, reflecting their high risk of diabetes and vascular disease. HbA 1c can be used as an opportunistic screening test for diabetes and glucose intolerance, but a high level should be followed by an oral glucose tolerance test. Copyright © 2004 John Wiley & Sons, Ltd.