Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/35418
Title: Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants
Authors: Goodarz Danaei
Saman Fahimi
Yuan Lu
Bin Zhou
Kaveh Hajifathalian
Mariachiara Di Cesare
Wei Cheng Lo
Barbara Reis-Santos
Melanie J. Cowan
Jonathan E. Shaw
James Bentham
John K. Lin
Honor Bixby
Dianna Magliano
Pascal Bovet
J. Jaime Miranda
Young Ho Khang
Gretchen A. Stevens
Leanne M. Riley
Mohammed K. Ali
Majid Ezzati
Khalid Abdul Kadir
Niveen M. Abu-Rmeileh
Benjamin Acosta-Cazares
Wichai Aekplakorn
Carlos A. Aguilar-Salinas
Alireza Ahmadvand
Mohannad Al Nsour
Ala'a Alkerwi
Philippe Amouyel
Lars Bo Andersen
Sigmund A. Anderssen
Dolores S. Andrade
Ranjit Mohan Anjana
Hajer Aounallah-Skhiri
Tahir Aris
Nimmathota Arlappa
Dominique Arveiler
Felix K. Assah
Mária Avdicová
Nagalla Balakrishna
Piotr Bandosz
Carlo M. Barbagallo
Alberto Barceló
Anwar M. Batieha
Louise A. Baur
Habiba Ben Romdhane
Antonio Bernabe-Ortiz
Santosh K. Bhargava
Yufang Bi
Peter Bjerregaard
Cecilia Björkelund
Margaret Blake
Anneke Blokstra
Simona Bo
Bernhard O. Boehm
Carlos P. Boissonnet
Imperia Brajkovich
Juergen Breckenkamp
Lizzy M. Brewster
Garry R. Brian
Graziella Bruno
Anna Bugge
Antonio Cabrera de León
Gunay Can
Ana Paula C. Cândido
Vincenzo Capuano
Maria J. Carvalho
Felipe F. Casanueva
Carmelo A. Caserta
Katia Castetbon
Snehalatha Chamukuttan
Nishi Chaturvedi
Chien Jen Chen
Fangfang Chen
Shuohua Chen
Ching Yu Cheng
Angela Chetrit
Shu Ti Chiou
Yumi Cho
Jerzy Chudek
Renata Cifkova
Frank Claessens
Hans Concin
Cyrus Cooper
Rachel Cooper
Simona Costanzo
Dominique Cottel
Chris Cowell
Ana B. Crujeiras
Graziella D'Arrigo
Jean Dallongeville
Rachel Dankner
Luc Dauchet
Giovanni de Gaetano
Stefaan de Henauw
Mohan Deepa
Abbas Dehghan
Harvard School of Public Health
Imperial College London
National Taiwan University
Universidade Federal de Pelotas
Organisation Mondiale de la Sante
Baker Heart and Diabetes Institute
University of California, San Francisco
Universitat Lausanne Schweiz
Universidad Peruana Cayetano Heredia
Seoul National University
Emory University
Monash University Malaysia
Birzeit University
Instituto Mexicano del Seguro Social
Mahidol University
Instituto Nacional de la Nutricion Salvador Zubiran
Tehran University of Medical Sciences
Eastern Mediterranean Public Health Network
Luxembourg Institute of Health
University of Lille
Syddansk Universitet
Norges idrettshogskole
University of Cuenca
Madras Diabetes Research Foundation
National Institute of Public Health
Kementerian Kesihatan Malaysia
Indian Council of Medical Research
Strasbourg University and Hospital
Health of Population in Transition Research Group (HoPiT)
Regional Authority of Public Health
Gdanski Uniwersytet Medyczny
Universita degli Studi di Palermo
Pan American Health Organization
Jordan University of Science and Technology
The University of Sydney
University of Tunis El Manar
Sunder Lal Jain Hospital
Shanghai Jiao Tong University School of Medicine
Goteborgs Universitet
NatCen Social Research
National Institute of Public Health and the Environment
Universita degli Studi di Torino
Nanyang Technological University
Centro de Educación Médica e Investigaciones Clínicas
Universidad Central de Venezuela
Universitat Bielefeld
University of Amsterdam
Fred Hollows Foundation, New Zealand
Canarian Health Service
Istanbul Universitesi
Reparto di Cardiologia ed UTIC di Mercato S.
Universidade do Porto
Universidad de Santiago de Compostela
Associazione Calabrese di Epatologia
French Institute for Health Surveillance
India Diabetes Research Foundation
UCL
Academia Sinica Taiwan
Capital Institute of Pediatrics
Kailuan General Hospital
Duke-NUS Medical School Singapore
The Gertner Institute
Ministry of Health and Welfare
Korea Centers for Disease Control & Prevention
Slaski Uniwersytet Medyczny w Katowicach
Charles University
KU Leuven
Agency for Preventive
University of Southampton
IRCCS Istituto Neurologico Mediterraneo Neuromed
Institut Pasteur Lille
CIBERobn
Consiglio Nazionale delle Ricerche
Centre Hospitalier Regional Universitaire de Lille
Universiteit Gent
Erasmus University Medical Center
Ministry of Health Seychelles
University of Greenland
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 1-Aug-2015
Citation: The Lancet Diabetes and Endocrinology. Vol.3, No.8 (2015), 624-637
Abstract: © 2015 NCD Risk Factor Collaboration. Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84938199196&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/35418
ISSN: 22138595
22138587
Appears in Collections:Scopus 2011-2015

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