TY - JOUR
T1 - Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c
AU - NCD Risk Factor Collaboration (NCD-RisC)
AU - Zhou, Bin
AU - Sheffer, Kate E.
AU - Bennett, James E.
AU - Gregg, Edward W.
AU - Danaei, Goodarz
AU - Singleton, Rosie K.
AU - Shaw, Jonathan E.
AU - Mishra, Anu
AU - Lhoste, Victor P.F.
AU - Carrillo-Larco, Rodrigo M.
AU - Kengne, Andre P.
AU - Phelps, Nowell H.
AU - Heap, Rachel A.
AU - Rayner, Archie W.
AU - Stevens, Gretchen A.
AU - Paciorek, Chris J.
AU - Riley, Leanne M.
AU - Cowan, Melanie J.
AU - Savin, Stefan
AU - Vander Hoorn, Stephen
AU - Lu, Yuan
AU - Pavkov, Meda E.
AU - Imperatore, Giuseppina
AU - Aguilar-Salinas, Carlos A.
AU - Ahmad, Noor Ani
AU - Anjana, Ranjit Mohan
AU - Davletov, Kairat
AU - Farzadfar, Farshad
AU - González-Villalpando, Clicerio
AU - Khang, Young Ho
AU - Kim, Hyeon Chang
AU - Laatikainen, Tiina
AU - Laxmaiah, Avula
AU - Mbanya, Jean Claude N.
AU - Narayan, K. M.Venkat
AU - Ramachandran, Ambady
AU - Wade, Alisha N.
AU - Zdrojewski, Tomasz
AU - Abbasi-Kangevari, Mohsen
AU - Rahim, Hanan F.Abdul
AU - Abu-Rmeileh, Niveen M.
AU - Adambekov, Shalkar
AU - Adams, Robert J.
AU - Aekplakorn, Wichai
AU - Agdeppa, Imelda A.
AU - Aghazadeh-Attari, Javad
AU - Agyemang, Charles
AU - Ahmadi, Ali
AU - König, Jürgen
AU - Rust, Petra
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
AB - Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
UR - http://www.scopus.com/inward/record.url?scp=85176735771&partnerID=8YFLogxK
U2 - 10.1038/s41591-023-02610-2
DO - 10.1038/s41591-023-02610-2
M3 - Article
C2 - 37946056
AN - SCOPUS:85176735771
VL - 29
SP - 2885
EP - 2901
JO - Nature Medicine
JF - Nature Medicine
SN - 1078-8956
IS - 11
ER -