Discordance in the diagnosis of diabetes: Comparison between HbA1c and fasting plasma glucose

Ho-Pham, LT; Nguyen, UDT; Tran, TX; Nguyen, TV

Discordance in the diagnosis of diabetes: Comparison between HbA1c and fasting plasma glucose

Ho-Pham, LT Nguyen, UDT Tran, TX Nguyen, TV

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Publication Type:: Journal Article
Citation:: PLoS ONE, 2017, 12 (8)
Issue Date:: 2017-08-01

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Field	Value	Language
dc.contributor.author	Ho-Pham, LT	en_US
dc.contributor.author	Nguyen, UDT	en_US
dc.contributor.author	Tran, TX	en_US
dc.contributor.author	Nguyen, TV https://orcid.org/0000-0002-3246-6281	en_US
dc.date.available	2017-07-13	en_US
dc.date.issued	2017-08-01	en_US
dc.identifier.citation	PLoS ONE, 2017, 12 (8)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124174
dc.description.abstract	© 2017 Ho-Pham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective HbA1c has been introduced as a complementary diagnostic test for diabetes, but its impact on disease prevalence is unknown. This study evaluated the concordance between HbA1c and fasting plasma glucose (FPG) in the diagnosis of diabetes in the general population. Materials and methods The study was designed as a population based investigation, with participants being sampled from the Ho Chi Minh City, Vietnam. Blood samples were collected after overnight fasting and analyzed within 4 hours after collection. HbA1c was measured with high pressure liquid chromatography (Arkray Adams, Japan). FPG was measured by the hexokinase method (Advia Autoanalyzer; Bayer Diagnostics, Germany). Diabetes was defined as HbA1c 6.5% or FPG 7.0 mmol/L. Prediabetes was classified as HbA1c between 5.7% and 6.4%. Results The study included 3523 individuals (2356 women) aged 30 years and above. Based on the HbA1c test, the prevalence of diabetes and prediabetes was 9.7% (95%CI, 8.7–10.7%; n = 342) and 34.6% (33.0–36.2; n = 1219), respectively. Based on the FPG test, the prevalence of diabetes and prediabetes was 6.3% (95%CI, 5.5–7.2%; n = 223) and 12.1% (11.1–13.2; n = 427). Among the 427 individuals identified by FPG as "pre-diabetes", 28.6% were classified as diabetes by HbA1c test. The weighted kappa statistic of concordance between HbA1c and FPG was 0.55, with most of the discordance being in the prediabetes group. Conclusion These data indicate that there is a significant discordance in the diagnosis of diabetes between FPG and HbA1c measurements, and the discordance could have significant impact on clinical practice. FPG appears to underestimate the burden of undiagnosed diabetes.	en_US
dc.relation.ispartof	PLoS ONE	en_US
dc.relation.isbasedon	10.1371/journal.pone.0182192	en_US
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	General Science & Technology	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Biomarkers	en_US
dc.subject.mesh	Blood Glucose	en_US
dc.subject.mesh	Diabetes Mellitus, Type 2	en_US
dc.subject.mesh	Fasting	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Glycated Hemoglobin A	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	ROC Curve	en_US
dc.subject.mesh	Reproducibility of Results	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Vietnam	en_US
dc.title	Discordance in the diagnosis of diabetes: Comparison between HbA1c and fasting plasma glucose	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	12	en_US
utslib.for	110316 Pathology (excl. Oral Pathology)	en_US
utslib.for	0903 Biomedical Engineering	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
utslib.copyright.status	open_access	*
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	12	en_US

Abstract:

© 2017 Ho-Pham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective HbA1c has been introduced as a complementary diagnostic test for diabetes, but its impact on disease prevalence is unknown. This study evaluated the concordance between HbA1c and fasting plasma glucose (FPG) in the diagnosis of diabetes in the general population. Materials and methods The study was designed as a population based investigation, with participants being sampled from the Ho Chi Minh City, Vietnam. Blood samples were collected after overnight fasting and analyzed within 4 hours after collection. HbA1c was measured with high pressure liquid chromatography (Arkray Adams, Japan). FPG was measured by the hexokinase method (Advia Autoanalyzer; Bayer Diagnostics, Germany). Diabetes was defined as HbA1c 6.5% or FPG 7.0 mmol/L. Prediabetes was classified as HbA1c between 5.7% and 6.4%. Results The study included 3523 individuals (2356 women) aged 30 years and above. Based on the HbA1c test, the prevalence of diabetes and prediabetes was 9.7% (95%CI, 8.7–10.7%; n = 342) and 34.6% (33.0–36.2; n = 1219), respectively. Based on the FPG test, the prevalence of diabetes and prediabetes was 6.3% (95%CI, 5.5–7.2%; n = 223) and 12.1% (11.1–13.2; n = 427). Among the 427 individuals identified by FPG as "pre-diabetes", 28.6% were classified as diabetes by HbA1c test. The weighted kappa statistic of concordance between HbA1c and FPG was 0.55, with most of the discordance being in the prediabetes group. Conclusion These data indicate that there is a significant discordance in the diagnosis of diabetes between FPG and HbA1c measurements, and the discordance could have significant impact on clinical practice. FPG appears to underestimate the burden of undiagnosed diabetes.

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