Publication:
Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants

Issued Date

2015-08-01

Resource Type

Article

ISSN

22138595
22138587

DOI

10.1016/S2213-8587(15)00129-1

Other identifier(s)

2-s2.0-84938199196

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Diabetes and Endocrinology. Vol.3, No.8 (2015), 624-637

Suggested Citation

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 Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants. The Lancet Diabetes and Endocrinology. Vol.3, No.8 (2015), 624-637. doi:10.1016/S2213-8587(15)00129-1 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/35418

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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

Author(s)

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

Other Contributor(s)

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

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.

Keyword(s)

Biochemistry, Genetics and Molecular Biology
 Medicine

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URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/35418

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