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Journal ArticleDOI

Comparison of Hemoglobin A1c with Fasting and 2-h Plasma Glucose Tests for Diagnosis of Diabetes and Prediabetes among High-risk South Indians.

TL;DR: HbA1c ≥6.5% is a convenient and reliable alternative to plasma glucose tests to diagnose diabetes among high-risk South Indians and 0.6% had 100% negative predictive value to exclude prediabetes/diabetes.
Abstract: Background: Glycosylated hemoglobin (HbA1c) has not been evaluated extensively for diabetes and prediabetes diagnosis and short-term variability of fasting plasma glucose (FPG), 2-h PG post-75 g glucose load (2 hPG) and HbA1c has not been studied among Indians. Objectives: The study aimed to compare the sensitivity of HbA1c, FPG and 2 hPG for diabetes and prediabetes diagnosis as per the American Diabetes Association criteria, assess short-term variability of three tests and determine optimal HbA1c cutoffs for diabetes and prediabetes diagnosis among high-risk south Indians. Methods: This diagnostic accuracy study, conducted at a tertiary care teaching hospital located in South India, enrolled 332 adults at high risk for diabetes and subjected them to testing (FPG, 2 hPG, and HbA1c) twice at 2–3 weeks interval. Sensitivity of three tests for diagnosing diabetes and prediabetes was determined based on the final diagnosis of normoglycemia/prediabetes/diabetes made with six test results for each participant. Optimal HbA1c cutoffs for diabetes and prediabetes were determined based on the final diagnosis of glycemic status made with four test results of FPG and 2 hPG. Results: FPG, 2 hPG, and HbA1c, at American Diabetes Association recommended values, had sensitivity of 84.4%, 97%, and 93.8% respectively for diabetes diagnosis. HbA1c had lowest short-term variability (CVw = 1.6%). Receiver operating characteristic curve plotted with mean (of two values) HbA1c for each participant showed optimal HbA1c cutoffs of 6.5% for diabetes (area under curve [AUC] =0.990, sensitivity = 95.8%, specificity = 96.2%, accuracy = 95.2%) and 5.9% for prediabetes (AUC = 0.893, sensitivity = 84.3%, specificity = 80%, accuracy = 75.6%) diagnosis respectively. HbA1c
Citations
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Journal ArticleDOI
TL;DR: The present paper presents a meta-analysis of 148 cases of type 2 diabetes patients treated at the UCMS-GTB Hospital in Ahmedabad over a 12-month period from May 2013 to March 2014 that showed clear trends in disease progression and in particular in cases of high blood pressure and insulin resistance.
Abstract: Rajeev Chawla1, S. V. Madhu2, B. M. Makkar3, Sujoy Ghosh4, Banshi Saboo5, Sanjay Kalra6, On behalf of the RSSDI-ESI Consensus Group* 1North Delhi Diabetes Centre, Rohini, New Delhi, 2Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, 3Dr. Makkar’s Diabetes and Obesity Centre, Paschim Vihar, New Delhi, 4Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, 5DiaCare A Complete Diabetes Care Centre, Ahmedabad, Gujarat, 6Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India

84 citations

Journal ArticleDOI
TL;DR: The present paper presents a meta-analysis of 148 cases of type 2 diabetes patients treated at the UCMS-GTB Hospital in Ahmedabad over a 12-month period from May 2013 to March 2014 that showed clear trends in disease progression and in particular in cases of high blood pressure and insulin resistance.
Abstract: Rajeev Chawla1, S. V. Madhu2, B. M. Makkar3, Sujoy Ghosh4, Banshi Saboo5, Sanjay Kalra6, On behalf of the RSSDI-ESI Consensus Group* 1North Delhi Diabetes Centre, Rohini, New Delhi, 2Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, 3Dr. Makkar’s Diabetes and Obesity Centre, Paschim Vihar, New Delhi, 4Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, 5DiaCare A Complete Diabetes Care Centre, Ahmedabad, Gujarat, 6Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India

21 citations


Cites background from "Comparison of Hemoglobin A1c with F..."

  • ...[6,7] Moreover, measuring HbA1c is expensive as compared to FPG assessments and standardization of measurement techniques and laboratories are poorly practiced across the country.[8] Also, in several countries including India, HbA1c demonstrated inadequate predictive accuracy in the diagnosis of diabetes, there is no consensus on a suitable cut-off point of HbA1c for diagnosis of diabetes in this high-risk population....

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  • ...Infections in diabetes • Several factors have been implicated for infections in diabetes, of which, altered immunity is the most predominant one.[4,8] Other predisposing factors...

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  • ...6% excludes prediabetes/diabetes status.[8]...

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Journal ArticleDOI
TL;DR: This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes.
Abstract: There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

16 citations

Journal ArticleDOI
TL;DR: Findings from second NDSP demonstrated disagreement between findings of OGTT and HbA1c as diagnostic tool for Pakistani population, which might require ethnic or regional-based modification in cut-off points.
Abstract: Aim Glycated hemoglobin (HbA1c) cut-off values as diagnostic tool in diabetes and prediabetes with its concordance to oral glucose tolerance test (OGTT) in Pakistani population. Methodology Data for this substudy was obtained from second National Diabetes Survey of Pakistan (NDSP) 2016–2017. With this survey, 10 834 individuals were recruited and after excluding known subjects with diabetes, 6836 participants fulfilled inclusion criteria for this study. Demographic, anthropometric and biochemical parameters were obtained. OGTT was used as standard diagnostic tool to screen population and HbA1c for optimal cut-off values. Participants were categorized into normal glucose tolerance (NGT), newly diagnosed diabetes (NDD) and prediabetes. Results Out of 6836 participants, 4690 (68.6%) had NGT, 1333 (19.5%) had prediabetes and 813 (11.9%) had NDD by OGTT criteria with median (IQR) age of 40 (31–50) years. Optimal HbA1c cut-off point for identification of diabetes and prediabetes was observed as 5.7% ((AUC (95% CI)=0.776 (0.757 to 0.795), p Conclusion Findings from second NDSP demonstrated disagreement between findings of OGTT and HbA1c as diagnostic tool for Pakistani population. As compared with international guidelines, HbA1c threshold for prediabetes and NDD were lower in this part of world. HbA1c as diagnostic tool might require ethnic or regional-based modification in cut-off points, validated by relevant community-based epidemiological surveys.

7 citations

Journal ArticleDOI
TL;DR: The heritability estimates of T2D in the CH, RE, SI, and AG EEGs were found to be 30%, 46%, 54%, and 82% respectively, and statistically significant (P ≤ 0.05).
Abstract: To assess the burden of type 2 diabetes (T2D) and its genetic profile in endogamous populations of India given the paucity of data, we aimed to determine the prevalence of T2D and estimate its heritability using family-based cohorts from three distinct Endogamous Ethnic Groups (EEGs) representing Northern (Rajasthan [Agarwals: AG]) and Southern (Tamil Nadu [Chettiars: CH] and Andhra Pradesh [Reddys: RE]) states of India. For comparison, family-based data collected previously from another North Indian Punjabi Sikh (SI) EEG was used. In addition, we examined various T2D-related cardiometabolic traits and determined their heritabilities. These studies were conducted as part of the Indian Diabetes Genetic Studies in collaboration with US (INDIGENIUS) Consortium. The pedigree, demographic, phenotypic, covariate data and samples were collected from the CH, AG, and RE EEGs. The status of T2D was defined by ADA guidelines (fasting glucose ≥ 126 mg/dl or HbA1c ≥ 6.5% and/or use of diabetes medication/history). The prevalence of T2D in CH (N = 517, families = 21, mean age = 47y, mean BMI = 27), AG (N = 530, Families = 25, mean age = 43y, mean BMI = 27), and RE (N = 500, Families = 22, mean age = 46y, mean BMI = 27) was found to be 33%, 37%, and 36%, respectively, Also, the study participants from these EEGs were found to be at increased cardiometabolic risk (e.g., obesity and prediabetes). Similar characteristics for the SI EEG (N = 1,260, Families = 324, Age = 51y, BMI = 27, T2D = 75%) were obtained previously. We used the variance components approach to carry out genetic analyses after adjusting for covariate effects. The heritability (h2) estimates of T2D in the CH, RE, SI, and AG were found to be 30%, 46%, 54%, and 82% respectively, and statistically significant (P ≤ 0.05). Other T2D related traits (e.g., BMI, lipids, blood pressure) in AG, CH, and RE EEGs exhibited strong additive genetic influences (h2 range: 17% [triglycerides/AG and hs-CRP/RE] - 86% [glucose/non-T2D/AG]). Our findings highlight the high burden of T2D in Indian EEGs with significant and differential additive genetic influences on T2D and related traits.

2 citations

References
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Journal ArticleDOI
TL;DR: Diabetes prevalence, deaths attributable to diabetes, and health expenditure due to diabetes continue to rise across the globe with important social, financial and health system implications.

5,474 citations

Journal ArticleDOI
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.
Abstract: D iabetes is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude clinical judgment or more extensive evaluation and management of the patient by other specialists as needed. For more detailed information about management of diabetes, refer to references 1–3. The recommendations included are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was used to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. These standards of care are revised annually by the ADA multidisciplinary Professional Practice Committee, and new evidence is incorporated. Members of the Professional Practice Committee and their disclosed conflicts of interest are listed in the Introduction. Subsequently, as with all position statements, the standards of care are reviewed and approved by the Executive Committee of ADA’s Board of Directors.

3,405 citations

Journal ArticleDOI
TL;DR: Age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes and prediabetes in India.
Abstract: Aims/hypothesis This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India.

730 citations


"Comparison of Hemoglobin A1c with F..." refers result in this paper

  • ...Methods: This diagnostic accuracy study, conducted at a tertiary care teaching hospital located in South India, enrolled 332 adults at high risk for diabetes and subjected them to testing (FPG, 2 hPG, and HbA1c) twice at 2–3 weeks interval....

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  • ...Further larger community-based studies from different parts of India, involving participants at different levels of risk for diabetes and employing tests twice, would be needed for ascertaining the role of HbA1c vis‑à‑vis plasma glucose tests....

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  • ...[7] The frequency of diabetes and prediabetes in the present study was expectedly two to three times of their reported prevalence in earlier population-based studies from India,[6,7,9,22,23] because of higher metabolic risk among participants....

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Journal ArticleDOI
TL;DR: High variability in 2-hour glucose levels relative to fasting glucose levels and high variability in HbA1c levels are found and suggest that studies that strictly apply guidelines for the diagnosis of diabetes may arrive at substantially different prevalence estimates compared with studies that use only a single measurement.
Abstract: Background Short-term variability in measures of glycemia has important implications for the diagnosis of diabetes mellitus and the conduct and interpretation of epidemiologic studies. Our objectives were to characterize the within-person variability in fasting glucose, 2-hour glucose, and hemoglobin A 1c (HbA 1c ) levels and to assess the impact of using repeated measurements for classification of diabetes. Methods We analyzed repeated measurements from 685 fasting participants without diagnosed diabetes from the National Health and Nutrition Examination Survey III Second Examination, a substudy conducted from 1988 to 1994 in which repeated examinations were conducted approximately 2 weeks after the original examination. Results Two-hour glucose levels had substantially more variability (within-person coefficient of variation [CV w ], 16.7%; 95% confidence interval [CI], 15.0 to 18.3) compared with either fasting glucose (CV w , 5.7%; 95% CI, 5.3 to 6.1) or HbA 1c (CV w, 3.6%; 95% CI, 3.2 to 4.0) levels. The proportion of persons with a fasting glucose level of 126 mg/dL or higher (to convert to millimoles per liter, multiply by 0.0555) on the first test who also had a second glucose level of 126 mg/dL or higher was 70.4% (95% CI, 49.8% to 86.2%). Results were similar using the 2-hour glucose cutoff point of 140 mg/dL or higher. The prevalence of undiagnosed diabetes using a single fasting glucose level of 126 mg/dL or higher was 3.7%. If a second fasting glucose level of 126 mg/dL or higher was used to confirm the diagnosis (American Diabetes Association guidelines), the prevalence decreased to 2.8% (95% CI, 1.5% to 4.0%), a 24.4% decrease. Conclusions We found high variability in 2-hour glucose levels relative to fasting glucose levels and high variability in both of these relative to HbA 1c levels. Our findings suggest that studies that strictly apply guidelines for the diagnosis of diabetes (2 glucose measurements) may arrive at substantially different prevalence estimates compared with studies that use only a single measurement.

367 citations


"Comparison of Hemoglobin A1c with F..." refers background or methods or result in this paper

  • ...[2] Variability of FPG, 2-h plasma glucose post-75 g oral glucose load (2 hPG) and HbA1c over a short duration[10] has most probably not been studied in the Indian population so far....

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  • ...[10] This may be due to the differences in race and risk profile of participants for diabetes in the present study versus that of Selvin et al.[10]...

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  • ...[5,10] HbA1c was the least variable of three diagnostic tests for diabetes over a short duration of 2–3 weeks in the present study, similar to earlier studies.[5,10] Thus, unlike PG tests, HbA1c may have the advantage of achieving diabetes diagnosis after single testing, provided the assay well-standardized and test is utilized judiciously considering its nonreliability in certain situations....

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  • ...[10] This may be due to the differences in race and risk profile of participants for diabetes in the present study versus that of Selvin et al.[10] Optimal HbA1c cutoff determined for diabetes diagnosis in the present study matched with ADA recommended cutoff of 6.5% and had high accuracy of ≈ 95%....

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  • ...Differences were calculated as visit 1 minus visit 2, the within-person coefficients of variation were calculated as the square root of the within‐subject variance divided by the mean squared and their confidence intervals were obtained using bootstrap methods.[10]...

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Journal ArticleDOI
TL;DR: An International Expert Committee was convened in 2008 by the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation to consider the means for diagnosing diabetes in nonpregnant individuals, with particular focus on the possibility to indicate A1C as an alternative if not a better tool.
Abstract: An International Expert Committee was convened in 2008 by the American Diabetes Association (ADA), the European Association for the Study of Diabetes, and the International Diabetes Federation to consider the means for diagnosing diabetes in nonpregnant individuals, with particular focus on the possibility to indicate A1C as an alternative if not a better tool (1). After reviewing the available literature and a thorough discussion on the advantages and the limits of previous diagnostic strategies (essentially based on fasting glucose assessment) and the considered alternative approach (based on A1C measurement), a consensus was reached that the latter (i.e., A1C) should be included among diagnostic tools for diabetes and, with the exception of a number of clinical conditions, should even be preferred in diabetes diagnosis in nonpregnant adults. The main conclusion of the International Expert Committee was implemented in the most recent clinical recommendations issued by the ADA. However, in these guidelines, A1C is indicated as a diagnostic tool alternative but not superior to blood glucose, leaving to the health care professional the decision about what test to use in an individual. The World Health Organization is currently examining the proposal made by the International Expert Committee and is carefully addressing the controversial issues still remaining, most of which have been the subject of letters to the editor and articles recently published in the literature. Nevertheless, the use of A1C for diagnosing diabetes is rapidly becoming a reality in many Western countries. In the text that follows, one of us (E.B.) will present the main points supporting A1C (pros) and the other (J.T.) will illustrate the main counterpoints challenging A1C (cons) as the primary tool for diabetes diagnosis. The text has been prepared in full coordination and the final conclusions represent the opinion of both authors. Tables 1 and 2 summarize the …

320 citations


"Comparison of Hemoglobin A1c with F..." refers background or result in this paper

  • ...[5,10] HbA1c was the least variable of three diagnostic tests for diabetes over a short duration of 2–3 weeks in the present study, similar to earlier studies.[5,10] Thus, unlike PG tests, HbA1c may have the advantage of achieving diabetes diagnosis after single testing, provided the assay well-standardized and test is utilized judiciously considering its nonreliability in certain situations....

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  • ...HbA1c, being a measure of average PG over prior 2–3 months, is a better marker of long-term hyperglycemia compared to FPG or 2 hPG tested twice and is better associated with chronic complications of diabetes,[5] especially microvascular ones....

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  • ...HbA1c offers some advantages over PG tests.[5] It is more convenient to perform (can be done at any time of day and no need for overnight fasting and glucose challenge); and hence better compliance with testing, has lowest variability (unaffected by stress, acute illness and changes in diet and physical activity just before testing) and the values would not be affected by delayed analysis of blood samples after collection, unlike PG tests....

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  • ...2 hPG has been found to be the most variable and HbA1c to be the least variable among diagnostic tests for diabetes in the previous studies.[5,10] HbA1c was the least variable of three diagnostic tests for diabetes over a short duration of 2–3 weeks in the present study, similar to earlier studies....

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