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HbA 1c as a diagnostic tool for diabetes and pre‐diabetes: the Bangladesh experience
Author(s) -
Bhowmik B.,
Diep L. M.,
Munir S. B.,
Rahman M.,
Wright E.,
Mahmood S.,
Afsana F.,
Ahmed T.,
Khan A. K. A.,
Hussain A.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12088
Subject(s) - medicine , diabetes mellitus , receiver operating characteristic , area under the curve , gold standard (test) , glucose tolerance test , plasma glucose , population , type 2 diabetes , impaired glucose tolerance , endocrinology , insulin resistance , environmental health
Aims To evaluate HbA 1c as a tool for the diagnosis of diabetes and pre‐diabetes (impaired glucose tolerance and/or impaired fasting glucose) and to identify the optimal cut‐off values suitable for a Bangladeshi population. Methods In this cross‐sectional survey in a rural community, 2293 randomly selected individuals aged ≥ 20 years without prior history of diabetes were included. HbA 1c and other clinical covariates necessary for the diagnosis of diabetes were recorded. Diabetes and pre‐diabetes were defined according to the World Health Organization 1999 criteria. The receiver operating characteristic curve was used to determine the performance of HbA 1c . Results The prevalences of diabetes and pre‐diabetes were 7.9 and 8.6%, respectively. Based on receiver operating characteristic curve analysis, an HbA 1c cut‐off value of ≥ 42 mmol/mol (≥ 6.0%) gave an optimal sensitivity of 86.2% and specificity of 93.3%, with an area under the curve of 0.949 to predict diabetes using the oral glucose tolerance test as the gold standard; a cut‐off value of ≥ 38 mmol/mol (≥ 5.6%) gave an optimal sensitivity of 68.0% and specificity of 66.4%, with an area under the curve of 0.714 to predict pre‐diabetes. In subjects at high risk of diabetes, HbA 1c ≥ 42 mmol/mol (≥ 6.0%) showed higher sensitivity than fasting plasma glucose ≥ 7.0 mmol/l, 2‐h plasma glucose ≥ 11.1 mmol/l and HbA 1c ≥ 48 mmol/mol (≥ 6.5%). Conclusions An HbA 1c cut‐off value of ≥ 42 mmol/mol (≥ 6.0%) was highly sensitive and specific in diagnosing diabetes mellitus. This optimal cut‐off level may be suitable as a diagnostic criterion for diabetes in a Bangladeshi population.