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Semadhi MP, Muliaty D, Halimah E, Levita J. Correlation between the Cognitive Status (SIRT1) and the Metabolic Function in Geriatric Patients Using the Indonesian Version of the Montreal Cognitive Assessment (MoCA-INA). Geriatrics (Basel) 2023; 8:119. [PMID: 38132490 PMCID: PMC10742712 DOI: 10.3390/geriatrics8060119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/30/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
A growing life expectancy may result in a chronic medical condition and multimorbidity because the aging process leads to a decrease in cognitive and physiological function. These risks may affect the quality of life of geriatrics. The present study aims to determine the correlation between cognitive status (in terms of SIRT1, a nicotinamide adenine dinucleotide (NAD+)-dependent class III deacetylase) and metabolic function (in terms of the lipid profile, kidney function, and blood glucose) in geriatric patients. The differences in the parameters of metabolic function in the participants' cognitive status were determined by using the Indonesian version of the Montreal Cognitive Assessments (MoCA-Ina). The elderly participants (n = 120) were recruited at three sites in Indonesia from March to October 2022. Our study demonstrated a negative correlation between the cognitive status of geriatric patients and their metabolic function, represented by the MoCA-Ina score with a linear regression equation of y = 0.27 - 2.4 ×10-3x. Higher levels of LDL-C, cystatin C, and HbA1c were found in the Severe-Moderate Cognitive Impairment group. Determining the SIRT1 levels may be beneficial in predicting both the cognitive and metabolic status of geriatrics because this protein is among numerous metabolic sensors in the hypothalamus.
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Affiliation(s)
- Made Putra Semadhi
- Prodia National Reference Laboratory, Jakarta 10430, Indonesia;
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang 45363, Indonesia
| | - Dewi Muliaty
- Prodia Widyahusada Tbk., Jakarta 10430, Indonesia;
| | - Eli Halimah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang 45363, Indonesia;
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang 45363, Indonesia;
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Ahmed SF, Hassan AA, Eltayeb MM, Omar SM, Adam I. Ethnicity, Age, and Gender Differences in Glycated Hemoglobin (HbA1c) Levels among Adults in Northern and Eastern Sudan: A Community-Based Cross-Sectional Study. Life (Basel) 2023; 13:2017. [PMID: 37895397 PMCID: PMC10608095 DOI: 10.3390/life13102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The level of association between glycated hemoglobin (HbA1c) level and ethnicity, age, and gender is not yet settled. This study aimed to investigate the association between ethnicity, age, and gender and HbA1c level among adults who were known not to have diabetes mellitus in northern and eastern Sudan. METHODS A comparative community-based cross-sectional study was conducted. Sociodemographic and clinical characteristics data were collected. HbA1c levels were measured, and multiple linear regression analysis was performed. RESULTS A total of 898 adults (363 in northern Sudan and 535 in eastern Sudan) were included; 349 (38.9%) were males. The HbA1c level was significantly higher in eastern Sudan, and there was no significant difference in HbA1c levels between genders. In multiple linear regression, for adults with HbA1c <6.5%, ethnicity and BMI were associated with HbA1c, but age and gender were not associated with HbA1c. In northern Sudan, age was positively associated with HbA1c, and there was no association between gender, BMI, and HbA1c in adults with HbA1c <6.5%. In eastern Sudan, BMI was positively associated with HbA1c, and there was no significant association between age and gender and HbA1c level in adults with HbA1c <6.5%. CONCLUSION HbA1c levels are influenced by ethnicity and age but not by gender.
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Affiliation(s)
- Sumia F. Ahmed
- Biochemistry Department, Faculty of Medicine, Najran University, Najran 664621, Saudi Arabia; (S.F.A.); (M.M.E.)
| | - Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum P.O. Box 102, Sudan;
| | - Majdolin M. Eltayeb
- Biochemistry Department, Faculty of Medicine, Najran University, Najran 664621, Saudi Arabia; (S.F.A.); (M.M.E.)
| | - Saeed M. Omar
- Faculty of Medicine, Gadarif University, Gadarif 32211, Sudan;
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
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Treister-Goltzman Y, Liberty IF, Peleg R. Ethnicity Affects A1C Levels in Patients With Diagnosed Type 2 Diabetes in Southern Israel. Diabetes Spectr 2023; 37:86-94. [PMID: 38385090 PMCID: PMC10877214 DOI: 10.2337/ds23-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Purpose To assess whether ethnicity affects the association between A1C and fasting glucose in people with type 2 diabetes. Methods This investigation was an epidemiological, cross-sectional study based on computerized medical records of the Southern District of Clalit Health Services. The study population comprised patients ≥40 years of age with type 2 diabetes who underwent blood tests between 8 August 2015 and 20 July 2020. A normal-error multiple linear regression model was used to assess differences in associations among ethnic groups (i.e., Arabs, Ethiopian Jews, and non-Ethiopian Jews) and A1C. Results A total of 59,432 patients with type 2 diabetes were included in the study. Of these, 1,804 were Jews of Ethiopian origin, 49,296 were non-Ethiopian Jews, and 8,332 were Arabs. Compared with non-Ethiopian Jews, A1C levels were increased by 0.1% (1 mmol/mol) among Ethiopian Jews and by 0.3% (3 mmol/mol) among Arabs. Ethnicity was a strong predictor of A1C, explaining 0.6% of its variance. An A1C level of 7% (53 mmol/mol) correlated with fasting glucose levels of 141, 136, and 126 mg/dL in non-Ethiopian Jews, Ethiopian Jews, and Arabs, respectively. Conclusion Ethnic differences in A1C should be considered by clinicians, researchers, and policymakers.
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Affiliation(s)
- Yulia Treister-Goltzman
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Haim Doron Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idit F. Liberty
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Diabetes Clinic, Soroka University Medical Center, Beer-Sheva, Israel
| | - Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Haim Doron Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Chen G, Zhang R, Tan C, Liu X, Yu L, Chen Y. Optimal glycated hemoglobin A1c value for prediabetes and diabetes in patients with pancreatic diseases. Front Endocrinol (Lausanne) 2023; 14:1208187. [PMID: 37484959 PMCID: PMC10358977 DOI: 10.3389/fendo.2023.1208187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Some articles suggest that using HbA1c alone for diabetes diagnosis is inappropriate. It requires considerable researches to explore the efficacy of HbA1c for diagnosing hyperglycemia in patients with pancreatic disease. METHODS This study analyzed 732 patients, comprising of 331 without pancreatic disease and 401 patients diagnosed with pancreatic diseases. All participants underwent the HbA1c assay and oral glucose tolerance test. Kappa coefficients were calculated to assess agreement between the HbA1c and glucose criteria. The receiver operating characteristic curve (ROC) was used to calculate the optimal HbA1c value. DeLong test was analyzed to compared the aera under curves (AUCs). RESULTS There were 203 (61.3%) patients with NGT, 78 (23.6%) with prediabetes, and 50 (15.1%) with diabetes in patients without pancreatic diseases. In patients with pancreatic disease, 106 participants were diagnosed with NGT (36.4%), 125 with prediabetes (31.2%), and 130 with diabetes (32.4%). Patients with pancreatic disease exhibited elevated levels of bilirubin, transaminase enzymes, aspartate transaminase, high density lipoprotein cholesterol and total bile acid. The sensitivity and specificity of the HbA1c (6.5%) for diagnosing pancreatic diabetes were 60.8% (95% CI 52.3, 69.3) and 92.6% (95% CI 89.5, 95.7). In prediabetes, the sensitivity and specificity of HbA1c (5.7%) is 53.2% (44.3, 62.0) and 59.6 (51.5, 67.6). The optimal HbA1c value for diagnosing diabetes was 6.0% (AUC = 0.876, 95% CI 0.839, 0.906), with the sensitivity of 83.8% and the specificity of 76.8%. The optimal HbA1c value for the diagnosis of prediabetes was 5.8% (AUC = 0.617, 95% CI: 0.556, 0.675), with the corresponding sensitivity and specificity of 48.0% and 72.6% respectively. The combined tests (HbA1c, 6.0% or FPG, 7.0mmol/L) presented the sensitivity of 85.7% (95% CI 79.1, 91.3)and the specificity of 92.6% (95% CI 87.6, 97.3) in pancreatic diabetes. CONCLUSION From our results, the recommended HbA1c by ADA criterion may not be sufficiently sensitive to diagnose hyperglycemia in pancreatic disease. The optimal value of 5.8% and 6.0% improved the accuracy for diagnosing prediabetes and diabetes and should be considered to be applied. Besides, we advocate the combination of HbA1c and FPG test for the diagnosis of diabetes in patients with pancreatic diseases.
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Affiliation(s)
- Guanhua Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Chunlu Tan
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xubao Liu
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Yonghua Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Cuadros DF, Li J, Musuka G, Awad SF. Spatial epidemiology of diabetes: Methods and insights. World J Diabetes 2021; 12:1042-1056. [PMID: 34326953 PMCID: PMC8311478 DOI: 10.4239/wjd.v12.i7.1042] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/07/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a growing epidemic with global proportions. It is estimated that in 2019, 463 million adults aged 20-79 years were living with DM. The latest evidence shows that DM continues to be a significant global health challenge and is likely to continue to grow substantially in the next decades, which would have major implications for healthcare expenditures, particularly in developing countries. Hence, new conceptual and methodological approaches to tackle the epidemic are long overdue. Spatial epidemiology has been a successful approach to control infectious disease epidemics like malaria and human immunodeficiency virus. The implementation of this approach has been expanded to include the study of non-communicable diseases like cancer and cardiovascular diseases. In this review, we discussed the implementation and use of spatial epidemiology and Geographic Information Systems to the study of DM. We reviewed several spatial methods used to understand the spatial structure of the disease and identify the potential geographical drivers of the spatial distribution of DM. Finally, we discussed the use of spatial epidemiology on the design and implementation of geographically targeted prevention and treatment interventions against DM.
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Affiliation(s)
- Diego F Cuadros
- Geography and Geographic Information Systems, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Jingjing Li
- Urban Health Collaborative, Drexel University, Philadelphia, PA 19104, United States
| | | | - Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine – Qatar, Cornell University, Doha 24144, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine – Qatar, Cornell University, Doha 24144, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10044, United States
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Overvad M, Diaz LJ, Bjerregaard P, Pedersen ML, Larsen CVL, Senftleber N, Grarup N, Hansen T, Jørgensen ME. The effect of diabetes and the common diabetogenic TBC1D4 p.Arg684Ter variant on cardiovascular risk in Inuit in Greenland. Sci Rep 2020; 10:22081. [PMID: 33328529 PMCID: PMC7745023 DOI: 10.1038/s41598-020-79132-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is a well-known complication of diabetes, but the association has not been studied among Inuit in Greenland. The aim was to examine the association between diabetes and incident CVD among Inuit in Greenland and determine if the common diabetogenic TBC1D4 variant confers increased risk of CVD. We followed an initial study population of 4127 adults in Greenland who had participated in at least one population-based health survey, in national registers. We used Poisson regression to calculate incidence rate ratios (IRR) of cardiovascular endpoints, comparing participants with and without diabetes and comparing homozygous TBC1D4 carriers with heterozygous carriers and non-carriers combined. Close to 10% had diabetes and age range was 18-96 years (45% male). Of the 3924 participants without prior CVD, 362 (~ 9%) had CVD events during a median follow-up of 10 years. Multivariate IRR for the effect of diabetes on CVD was 1.12 (95% CI: 0.80, 1.57) p = 0.50. Using a recessive genetic model, we compared homozygous TBC1D4 carriers with wildtype and heterozygous carriers combined, with a multivariate IRR of 1.20 (95% CI: 0.69, 2.11) p = 0.52. Neither diabetes nor the TBC1D4 variant significantly increased CVD risk among Inuit in Greenland in adjusted models.
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Affiliation(s)
- Maria Overvad
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
- Queen Ingrid Primary Health Care Center, Nuuk, Greenland
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
| | - Ninna Senftleber
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- The Bioinformatics Centre, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
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Saeedi Borujeni MJ, Esfandiary E, Baradaran A, Valiani A, Ghanadian M, Codoñer-Franch P, Basirat R, Alonso-Iglesias E, Mirzaei H, Yazdani A. Molecular aspects of pancreatic β-cell dysfunction: Oxidative stress, microRNA, and long noncoding RNA. J Cell Physiol 2019; 234:8411-8425. [PMID: 30565679 DOI: 10.1002/jcp.27755] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome is known as a frequent precursor of type 2 diabetes mellitus (T2D). This disease could affect 8% of the people worldwide. Given that pancreatic β-cell dysfunction and loss have central roles in the initiation and progression of the disease, the understanding of cellular and molecular pathways associated with pancreatic β-cell dysfunction can provide more information about the underlying pathways involved in T2D. Multiple lines evidence indicated that oxidative stress, microRNA, and long noncoding RNA play significant roles in various steps of diseases. Oxidative stress is one of the important factors involved in T2D pathogenesis. This could affect the function and survival of the β cell via activation or inhibition of several processes and targets, such as receptor-signal transduction, enzyme activity, gene expression, ion channel transport, and apoptosis. Besides oxidative stress, microRNAs and noncoding RNAs have emerged as epigenetic regulators that could affect pancreatic β-cell dysfunction. These molecules exert their effects via targeting a variety of cellular and molecular pathways involved in T2D pathogenesis. Here, we summarized the molecular aspects of pancreatic β-cell dysfunction. Moreover, we highlighted the roles of oxidative stress, microRNAs, and noncoding RNAs in pancreatic β-cell dysfunction.
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Affiliation(s)
- Mohammad Javad Saeedi Borujeni
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Esfandiary
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Baradaran
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Valiani
- Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mustafa Ghanadian
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pilar Codoñer-Franch
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Reyhane Basirat
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Amid Yazdani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Wu Y, Zhou R, Lai Z, Wang W, Li N, Du Y, Guo L, Qiu Y, Wang QT, Li Z. Monitoring novel modified hemoglobin using mass spectrometry contributes to accurate blood glucose management of the Han Chinese population. Clin Chim Acta 2019; 489:124-129. [DOI: 10.1016/j.cca.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/15/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF REVIEW Using a global perspective, this review collates evidence on the heterogeneity of prediabetes definitions and diagnostic methods, their clinical and public health implications, and discusses possible options for improvement. RECENT FINDINGS Our review notes that the concept of prediabetes is increasingly recognized worldwide, but against a background of non-uniform definition and diagnostic criteria. This results in widely varying burden estimation. Current evidence shows a variety of prediabetes phenotypes. This reflects biological and diagnostic heterogeneity, resulting from the use of different tests (glucose or HbA1C) and thresholds to define prediabetes. The biological and diagnostic variabilities have implications for the characterization of the burden of prediabetes, natural history, prognosis, screening, implementation of lifestyle or drug interventions to mitigate related health risks, and monitoring of the effects of such interventions.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Zhou X, Ruan X, Hao L, Zhou Y, Gu J, Qiu H, Wu K, Yu S, Rui X, Wang X, Liu X, Ke J, Zhao G, Sun Q. Optimal hemoglobin A1C cutoff value for diabetes mellitus and pre-diabetes in Pudong New Area, Shanghai, China. Prim Care Diabetes 2018; 12:238-244. [PMID: 29370998 DOI: 10.1016/j.pcd.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/15/2022]
Abstract
AIMS Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia. METHODS We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia. RESULTS The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC=0.798, 95%CI: 0.779-0.818) and 5.6% (AUC=0.655, 95%CI: 0.638-0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15-39 years: P=0.003, 40-49 years: P<0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis. CONCLUSIONS The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard.
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Affiliation(s)
- Xianfeng Zhou
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai 200032, China; Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaonan Ruan
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Lipeng Hao
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Yi Zhou
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Jianjun Gu
- Health and Family Planning Commission, Pudong New Area, No. 990, Chengshan Road, 200125 Shanghai, China
| | - Hua Qiu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Kang Wu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Siyu Yu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xinyi Rui
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaonan Wang
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Xiaolin Liu
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Juzhong Ke
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China
| | - Genming Zhao
- School of Public Health, Fudan University, No. 130, Dongan Road, Shanghai 200032, China.
| | - Qiao Sun
- Center for Disease Prevention and Control, Pudong Preventive Medicine Research Institute of Fudan University, Pudong New Area, No. 3039, Zhangyang Road, Shanghai 200136, China.
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Appel EVR, Moltke I, Jørgensen ME, Bjerregaard P, Linneberg A, Pedersen O, Albrechtsen A, Hansen T, Grarup N. Genetic determinants of glycated hemoglobin levels in the Greenlandic Inuit population. Eur J Hum Genet 2018; 26:868-875. [PMID: 29483669 PMCID: PMC5974304 DOI: 10.1038/s41431-018-0109-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 01/12/2018] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
We previously showed that a common genetic variant leads to a remarkably increased risk of type 2 diabetes (T2D) in the small and historically isolated Greenlandic population. Motivated by this, we aimed at discovering novel genetic determinants for glycated hemoglobin (HbA1C) and at estimating the effect of known HbA1C-associated loci in the Greenlandic population. We analyzed genotype data from 4049 Greenlanders generated using the Illumina Cardio-Metabochip. We performed the discovery association analysis by an additive linear mixed model. To estimate the effect of known HbA1C-associated loci, we modeled the effect in the European and Inuit ancestry proportions of the Greenlandic genome (EAPGG and IAPGG, respectively). After correcting for multiple testing, we found no novel significant associations. When we investigated loci known to associate with HbA1C levels, we found that the lead variant in the GCK locus associated significantly with HbA1C levels in the IAPGG ([Formula: see text]). Furthermore, for 10 of 15 known HbA1C loci, the effects in IAPGG were similar to the previously reported effects. Interestingly, the ANK1 locus showed a statistically significant ancestral population differential effect, with opposing directions of effect in the two ancestral populations. In conclusion, we found only 1 of the 15 known HbA1C loci to be significantly associated with HbA1C levels in the IAPGG and that two-thirds of the loci showed similar effects in Inuit as previously found in European and East Asian populations. Our results shed light on the genetic effects across ethnicities.
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Affiliation(s)
- Emil V R Appel
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark.
| | - Ida Moltke
- The Bioinformatics Centre, Department of Biology, University of Copenhagen, 2200, Copenhagen, Denmark
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, 1353, Copenhagen, Denmark
- Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Anders Albrechtsen
- The Bioinformatics Centre, Department of Biology, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
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12
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Booth RA, Jiang Y, Morrison H, Orpana H, Rogers Van Katwyk S, Lemieux C. Ethnic dependent differences in diagnostic accuracy of glycated hemoglobin (HbA1c) in Canadian adults. Diabetes Res Clin Pract 2018; 136:143-149. [PMID: 29203254 DOI: 10.1016/j.diabres.2017.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 01/30/2023]
Abstract
AIM Previous studies have shown varying sensitivity and specificity of hemoglobin A1c (HbA1c) to identify diabetes and prediabetes, compared to 2-h oral glucose tolerance testing (OGTT) and fasting plasma glucose (FPG), in different ethnic groups. Within the Canadian population, the ability of HbA1c to identify prediabetes and diabetes in First Nations, Métis and Inuit, East and South Asian ethnic groups has yet to be determined. METHODS We collected demographic, lifestyle information, biochemical results of glycemic status (FPG, OGTT, and HbA1c) from an ethnically diverse Canadian population sample, which included a purposeful sampling of First Nations, Métis, Inuit, South Asian and East Asian participants. RESULTS Sensitivity and specificity using Canadian Diabetes Association (CDA) recommended cut-points varied between ethnic groups, with greater variability for identification of prediabetes than diabetes. Dysglycemia (prediabetes and diabetes) was identified with a sensitivity and specificity ranging from 47.1% to 87.5%, respectively in Caucasians to 24.1% and 88.8% in Inuit. Optimal HbA1c ethnic-specific cut-points for dysglycemia and diabetes were determined by receiver operating characteristic (ROC) curve analysis. CONCLUSIONS Our sample showed broad differences in the ability of HbA1c to identify dysglycemia or diabetes in different ethnic groups. Optimal cut-points for dysglycemia or diabetes in all ethnic groups were substantially lower than CDA recommendations. Utilization of HbA1c as the sole biochemical diagnostic marker may produce varying degrees of false negative results depending on the ethnicity of screened individuals. Further research is necessary to identify and validate optimal ethnic specific cut-points used for diabetic screening in the Canadian population.
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Affiliation(s)
- Ronald A Booth
- Division of Biochemistry, The Ottawa Hospital, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Canada.
| | - Ying Jiang
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada
| | - Howard Morrison
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada
| | - Heather Orpana
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Psychology, University of Ottawa, Canada
| | - Susan Rogers Van Katwyk
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
| | - Chantal Lemieux
- Social Determinants and Science Integration Directorate, Public Health Agency of Canada, Canada; School of Psychology, University of Ottawa, Canada
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13
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Impact of demographics and disease progression on the relationship between glucose and HbA1c. Eur J Pharm Sci 2017; 104:417-423. [PMID: 28412484 DOI: 10.1016/j.ejps.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/20/2022]
Abstract
CONTEXT Several studies have shown that the relationship between mean plasma glucose (MPG) and glycated haemoglobin (HbA1c) may vary across populations. Especially race has previously been referred to shift the regression line that links MPG to HbA1c at steady-state (Herman & Cohen, 2012). OBJECTIVE To assess the influence of demographic and disease progression-related covariates on the intercept of the estimated linear MPG-HbA1c relationship in a longitudinal model. DATA Longitudinal patient-level data from 16 late-phase trials in type 2 diabetes with a total of 8927 subjects was used to study covariates for the relationship between MPG and HbA1c. The analysed covariates included age group, BMI, gender, race, diabetes duration, and pre-trial treatment. Differences between trials were taken into account by estimating a trial-to-trial variability component. PARTICIPANTS Participants included 47% females and 20% above 65years. 77% were Caucasian, 9% were Asian, 5% were Black and the remaining 9% were analysed together as other races. ANALYSIS Estimates of the change in the intercept of the MPG-HbA1c relationship due to the mentioned covariates were determined using a longitudinal model. RESULTS The analysis showed that pre-trial treatment with insulin had the most pronounced impact associated with a 0.34% higher HbA1c at a given MPG. However, race, diabetes duration and age group also had an impact on the MPG-HbA1c relationship. CONCLUSION Our analysis shows that the relationship between MPG and HbA1c is relatively insensitive to covariates, but shows small variations across populations, which may be relevant to take into account when predicting HbA1c response based on MPG measurements in clinical trials.
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14
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Nakagami T, Tanaka Y, Oya J, Kurita M, Isago C, Hasegawa Y, Ito A, Hirota N, Tsuzura R, Uchigata Y. Associations of HbA1c and fasting plasma glucose with incident diabetes: Implications for pre-diabetes thresholds in a Japanese population. Prim Care Diabetes 2016; 10:407-414. [PMID: 27515716 DOI: 10.1016/j.pcd.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/02/2016] [Accepted: 07/16/2016] [Indexed: 02/03/2023]
Abstract
AIMS This study assessed pre-diabetes (pre-DM) cutoffs for HbA1c and fasting plasma glucose (FPG) that were associated with an increased risk of incident DM. METHODS We evaluated 2267 non-diabetic Japanese health-check examinees (HbA1c: <6.5% [<48mmol/mol] and FPG: <7.0mmol/L) who were 30-79 years old and were followed-up for 5 years. Incident DM was defined as HbA1c of ≥6.5% (≥48mmol/mol), FPG of ≥7.0mmol/L, or physician-diagnosed DM. RESULTS During 11047 person-years, we identified 99 incident DM cases (4.3%). The incidence of DM increased with increasing baseline HbA1c or FPG levels, and the change points (95% confidence intervals) were 5.7% (5.6-5.7%; 39mmol/mol [38-39mmol/mol]) for HbA1c and 5.5mmol/L (5.5-5.6mmol/L) for FPG. The adjusted hazard ratios (HRs) for incident DM per one standard deviation-increase in HbA1c and FPG were 5.5 (4.4-6.8) and 4.0 (3.2-4.8), respectively. The adjusted HRs for incident DM were significantly higher at HbA1c of 5.7-6.4% (39-46mmol/mol) or FPG of 5.5-6.9mmol/L, compared to HbA1c of <5.7% (<39mmol/mol) or FPG of <5.5mmol/L. CONCLUSION The lower cut-offs for pre-DM may be 5.7% (39mmol/mol) for HbA1c and 5.5mmol/L for FPG in this Japanese population.
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Affiliation(s)
- Tomoko Nakagami
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Yuki Tanaka
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Oya
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moritoshi Kurita
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Chisato Isago
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yukiko Hasegawa
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Arata Ito
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoki Hirota
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Reika Tsuzura
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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15
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Selvin E. Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference. Diabetes Care 2016; 39:1462-7. [PMID: 27457637 PMCID: PMC4955930 DOI: 10.2337/dc16-0042] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Studies that have compared HbA1c levels by race have consistently demonstrated higher HbA1c levels in African Americans than in whites. These racial differences in HbA1c have not been explained by measured differences in glycemia, sociodemographic factors, clinical factors, access to care, or quality of care. Recently, a number of nonglycemic factors and several genetic polymorphisms that operate through nonglycemic mechanisms have been associated with HbA1c Their distributions across racial groups and their impact on hemoglobin glycation need to be systematically explored. Thus, on the basis of evidence for racial differences in HbA1c, current clinical guidelines from the American Diabetes Association state: "It is important to take…race/ethnicity…into consideration when using the A1C to diagnose diabetes." However, it is not clear from the guidelines how this recommendation might be actualized. So, the critical question is not whether racial differences in HbA1c exist between African Americans and whites; the important question is whether the observed differences in HbA1c level are clinically meaningful. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Herman provides his argument that the failure to acknowledge that HbA1c might be a biased measure of average glycemia and an unwillingness to rigorously investigate this hypothesis will slow scientific progress and has the potential to do great harm. In the counterpoint narrative below, Dr. Selvin argues that there is no compelling evidence for racial differences in the validity of HbA1c as a measure of hyperglycemia and that race is a poor surrogate for differences in underlying causes of disease risk.-William T. CefaluEditor in Chief, Diabetes Care.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, and Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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16
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Nielsen NO, Bjerregaard P, Rønn PF, Friis H, Andersen S, Melbye M, Lundqvist M, Cohen AS, Hougaard DM, Jørgensen ME. Associations between Vitamin D Status and Type 2 Diabetes Measures among Inuit in Greenland May Be Affected by Other Factors. PLoS One 2016; 11:e0152763. [PMID: 27073876 PMCID: PMC4830590 DOI: 10.1371/journal.pone.0152763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Epidemiological studies have provided evidence of an association between vitamin D insufficiency and type 2 diabetes. Vitamin D levels have decreased among Inuit in Greenland, and type 2 diabetes is increasing. We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes, and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population. METHODS 2877 Inuit (≥18 years) randomly selected for participation in the Inuit Health in Transition study were included. Fasting- and 2hour plasma glucose and insulin, C-peptide and HbA1c were measured, and associations with serum 25(OH)D3 were analysed using linear and logistic regression. A subsample of 330 individuals who also donated a blood sample in 1987, were furthermore included. RESULTS After adjustment, increasing serum 25(OH)D3 (per 10 nmol/L) was associated with higher fasting plasma glucose (0.02 mmol/L, p = 0.004), 2hour plasma glucose (0.05 nmol/L, p = 0.002) and HbA1c (0.39%, p<0.001), and with lower beta-cell function (-1.00 mmol/L, p<0.001). Serum 25(OH)D3 was positively associated with impaired fasting glycaemia (OR: 1.08, p = 0.001), but not with IGT or type 2 diabetes. CONCLUSIONS Our results did not support an association between low vitamin D levels and risk of type 2 diabetes. Instead, we found weak positive associations between vitamin D levels and fasting- and 2hour plasma glucose levels, HbA1c and impaired fasting glycaemia, and a negative association with beta-cell function, underlining the need for determination of the causal relationship.
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Affiliation(s)
- Nina O Nielsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Greeenland Centre for Health Research, University of Greenland, Nuuk, Greenland
| | - Pernille F Rønn
- Steno Diabetes Centre, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marika Lundqvist
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Arieh S Cohen
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - David M Hougaard
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Centre, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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17
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Leow MKS. Glycated Hemoglobin (HbA1c): Clinical Applications of a Mathematical Concept. Acta Inform Med 2016; 24:233-238. [PMID: 27708483 PMCID: PMC5037982 DOI: 10.5455/aim.2016.24.233-238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/05/2016] [Indexed: 11/15/2022] Open
Abstract
Background and purpose: Glycated hemoglobin (HbA1c) reflects the cumulative glucose exposure of erythrocytes over a preceding time frame proportional to erythrocyte survival. HbA1c is thus an areal function of the glucose-time curve, an educationally useful concept to aid teaching and clinical judgment. Methods: An ordinary differential equation is formulated as a parsimonious model of HbA1c. The integrated form yields HbA1c as an area-under-the-curve (AUC) of a glucose-time profile. The rate constant of the HbA1c model is then derived using the validated regression equation in the ADAG study that links mean blood glucose and HbA1c with a very high degree of goodness-of-fit. Results: This model has didactic utility to enable patients, biomedical students and clinicians to appreciate how HbA1c may be conceptually inferred from discrete blood glucose values using continuous glucose monitoring system (CGMS) or self-monitored blood glucose (SMBG) glucometer readings as shown in the examples. It can be appreciated how hypoglycemia can occur with rapid HbA1c decline despite poor glycemic control. Conclusions: Being independent of laboratory assay pitfalls, computed ‘virtual’ HbA1c serves as an invaluable internal consistency cross-check against laboratory-measured HbA1c discordant with SMBG readings suggestive of inaccurate/fraudulent glucometer records or hematologic disorders including thalassemia and hemoglobinopathy. This model could be implemented within portable glucometers, CGMS devices and even smartphone apps for deriving tentative ‘virtual’ HbA1c from serial glucose readings as an adjunct to measured HbA1c. Such predicted ‘virtual’ HbA1c readily accessible via glucometers may serve as feedback to modify behavior and empower diabetic patients to achieve better glycemic control.
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18
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Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World J Diabetes 2015; 6:850-67. [PMID: 26131326 PMCID: PMC4478580 DOI: 10.4239/wjd.v6.i6.850] [Citation(s) in RCA: 567] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/25/2015] [Accepted: 04/10/2015] [Indexed: 02/05/2023] Open
Abstract
The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults (10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes (37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development.
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19
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Raum P, Lamparter J, Ponto KA, Peto T, Hoehn R, Schulz A, Schneider A, Wild PS, Pfeiffer N, Mirshahi A. Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study. PLoS One 2015; 10:e0127188. [PMID: 26075604 PMCID: PMC4468098 DOI: 10.1371/journal.pone.0127188] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/12/2015] [Indexed: 12/14/2022] Open
Abstract
Objective Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany. Research Design and Methods The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases. Results Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively). Conclusions Our calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.
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Affiliation(s)
- Philipp Raum
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Julia Lamparter
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Katharina A. Ponto
- Department of Ophthalmology, University Medical Center, Mainz, Germany
- Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Center at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - René Hoehn
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Andreas Schulz
- Biomedical statistics, University Medical Center, Mainz, Germany
| | - Astrid Schneider
- Biomedical statistics, University Medical Center, Mainz, Germany
| | - Philipp S. Wild
- Center for thrombosis & haemostasis (CTH), University Medical Center, Mainz, Germany
- Department of Medicine II, University Medical Center, Mainz, Germany
- German Center for Heart and Circulations System Research (DZHK), University Medical Center, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Mainz, Germany
| | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Center, Mainz, Germany
- Dardenne Eye Hospital, Bonn, Germany
- * E-mail:
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20
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Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. INT J EVID-BASED HEA 2014; 11:317-29. [PMID: 24298927 DOI: 10.1111/1744-1609.12038] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.
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Affiliation(s)
- Brian Chee
- Department of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
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21
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Dahlqvist JR, Ørngreen MC, Witting N, Vissing J. Endocrine function over time in patients with myotonic dystrophy type 1. Eur J Neurol 2014; 22:116-22. [PMID: 25155546 DOI: 10.1111/ene.12542] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Patients with myotonic dystrophy type 1 (DM1) have an increased incidence of endocrine dysfunction. In this study, the temporal evolution of endocrine dysfunction in patients with DM1 was investigated. METHODS Endocrine function was assessed in 68 patients with DM1, in whom endocrine function had been followed, on average, for 8 years. The endocrine function was assessed by measuring the concentration of hormones and metabolites in blood and by validating libido with questionnaires. RESULTS At baseline, 30 of the 68 patients presented with at least one hormonal dysfunction. When re-evaluated after 8 years, 57 of 68 patients had endocrine dysfunction. Diabetic patients had increased from one to four. At follow-up, hyperparathyroidism occurred in 25% and abnormal thyroid-stimulating hormone in 21%, compared with 14% and 9% at baseline. Sixteen of 33 men had increased luteinizing hormone levels compared with seven at baseline. CONCLUSIONS Our findings show that endocrine abnormalities amongst patients with DM1 increase over time. Based on these findings it is suggested that correctable endocrine abnormalities should be monitored periodically in this patient group.
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Affiliation(s)
- J R Dahlqvist
- Neuromuscular Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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22
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George JA. Should haemoglobin A1cbe used for the diagnosis of diabetes mellitus in South Africa? JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2011.10872263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- JA George
- Department of Chemical Pathology, National Health Laboratory Service and University of Witwatersrand, Johannesburg
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23
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Gooding HC, Milliren C, St Paul M, Mansfield MJ, DiVasta A. Diagnosing dysglycemia in adolescents with polycystic ovary syndrome. J Adolesc Health 2014; 55:79-84. [PMID: 24560306 DOI: 10.1016/j.jadohealth.2013.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE Screening for impaired glucose tolerance (IGT) is recommended for adolescents with polycystic ovary syndrome (PCOS) with oral glucose tolerance test (OGTT). Whether glycated hemoglobin (HbA1c) can be used for screening in this patient population is unknown. We sought to determine the utility of HbA1c and 2-hour OGTT for diagnosing dysglycemia in adolescents with PCOS. METHODS This was a retrospective cohort study of 68 adolescents with PCOS seen in the Boston Children's Hospital Division of Adolescent Medicine between 2008 and 2011 and not known to have diabetes. Prevalence of dysglycemia (impaired fasting glucose, IGT, increased risk for diabetes, or diabetes mellitus as diagnosed by fasting plasma glucose, 2-hour OGTT, and/or HbA1c) and sensitivity and specificity of HbA1c for diagnosing dysglycemia compared with OGTT were assessed. RESULTS Twenty-four participants had abnormal glucose testing, including one participant (1.5%) who met criteria for diabetes mellitus and 23 participants (34%) who met criteria for impaired fasting glucose/IGT/prediabetes. More patients were identified as having dysglycemia by HbA1c than OGTT. Compared with OGTT, HbA1c had a sensitivity of 60% and a specificity of 69% for diagnosing dysglycemia. CONCLUSIONS In adolescents with PCOS, HbA1c had moderate sensitivity and specificity for detecting dysglycemia compared with OGTT. Clinicians should be aware that both tests have benefits and limitations, and the optimal test for follow-up requires further study.
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Affiliation(s)
- Holly Catherine Gooding
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Carly Milliren
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts
| | - Michelle St Paul
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - M Joan Mansfield
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Amy DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts
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Dalan R, Earnest A, Leow MKS. Ethnic variation in the correlation between fasting glucose concentration and glycated hemoglobin (HbA1c). Endocr Pract 2014; 19:812-7. [PMID: 23757612 DOI: 10.4158/ep12417.or] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to determine the relationship between fasting serum glucose (FSG) concentration and glycated hemoglobin-A1c (HbA1c) in the 3 ethnicities in Singapore after adjustment for demographic and therapeutic variables. METHODS Fasting serum glucose (FSG), HbA1c, and serum creatinine levels were simultaneously sampled from 575 patients with diabetes (389 Chinese, 97 Indians, 89 Malays) in this cross-sectional study between January and May 2008, and the results were subjected to multivariate linear regression analysis. RESULTS We found a significant interaction between FSG and ethnicity on HbA1c. The correlation between FSG and HbA1c among Chinese subjects was 0.25 (95% confidence interval [CI]:0.2-0.3) relative to the Malays (0.38, 95% CI: 0.30-0.45) after adjustment for age; gender; serum creatinine concentrations; body mass index (BMI); duration of diabetes; use of sulfonylureas, metformin, and insulin; and hemoglobin (Hb) and red cell indices (P = .005). Hence, for a given FSG, the predicted HbA1c will be higher in Malays compared to Chinese subjects. We did not observe a statistically significant difference between Indians and Malays with respect to the correlation between FSG and HbA1c. CONCLUSION We showed a higher correlation between HbA1c and FSG in Malay subjects relative to the Chinese in this cohort. The ethnic variation in the HbA1c-FSG relationship may be related to differences in percentage contribution by the FSG to overall HbA1c among ethnic groups. Future studies using continuous glucose monitoring (CGM) to elucidate the relative contributions by FSG and postprandial glucose (PPG) to the daily blood glucose profile and the overall HbA1c by ethnicity are required.
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Affiliation(s)
- Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore Yong Loo Lin School of Medicine, Singapore Duke-NUS Graduate Medical School, Singapore
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Andersen S, Rex KF, Noahsen P, Sørensen HCF, Larsen NH, Mulvad G, Laurberg P. Forty-five year trends in overweight and obesity in an indigenous arctic Inuit Society in transition and spatiotemporal trends. Am J Hum Biol 2014; 26:511-7. [PMID: 24796319 DOI: 10.1002/ajhb.22556] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Overweight and obesity associate with increased morbidity and premature death. Westernization of societies heralds rising obesity rates. A steep increase in body mass index (BMI) and overweight in Greenland from 1963 to 1998 led us to follow-up on height, weight, BMI, and rates of overweight among populations in Greenland and assess time trends between different stages of transition. METHODS BMI was calculated from height and weight measured on Inuit and non-Inuit aged 50 through 69 years surveyed in 1963, 1998, and 2008 in Ammassalik district in East Greenland and in 1998 and 2008 in the capital Nuuk in West Greenland. RESULTS A total of 1,186 were surveyed in 1963 (52 men/63 women), 1998 (309/226), and 2008 (297/239). BMI increased with time (P < 0.001; 1963/1998/2008 23.3/24.3/26.2 kg/m(2) ). In addition, BMI increased with urbanization in Inuit men (P = 0.001; settlements/town/city, in 1998, 23.9/24.9/25.5 kg/m(2) ; in 2008, 25.0/26.0/27.0 kg/m(2) ) while not in Inuit women (P = 0.18). The number of overweight Inuit (BMI >27 kg/m(2) ) increased with time in men (4.0/25.6/33.2% in 1963/1998/2008, P = 0.001) and in women (13.6/30.7/37.3%, P = 0.001). BMI was above 30 kg/m(2) in 2.0/10.8/17.5% of all Inuit men in 1963/1998/2008 (P = 0.003) and in 8.3%/23.0/24.5% of all Inuit women (P = 0.02) respectively. CONCLUSIONS Overweight and obesity rates rise with time and with societal transition in Greenland. Settlements and town are catching up with the city where the rate of increase is diminishing, although there were gender differences.
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Affiliation(s)
- Stig Andersen
- Arctic Health Research Centre, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Denmark; Department of Internal Medicine, Queen Ingrids Hospital, Nuuk, Greenland; Department of Geriatric Medicine, Aalborg University Hospital, Denmark
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Kharroubi AT, Darwish HM, Abu Al-Halaweh AI, Khammash UM. Evaluation of glycated hemoglobin (HbA1c) for diagnosing type 2 diabetes and prediabetes among Palestinian Arab population. PLoS One 2014; 9:e88123. [PMID: 24505401 PMCID: PMC3914917 DOI: 10.1371/journal.pone.0088123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/03/2014] [Indexed: 12/11/2022] Open
Abstract
The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes (≥ 126 mg/dL) and prediabetes (100–125 mg/dL). The area under the receiver operating characteristic curve (AUC) for HbA1c was 81.9% to diagnose diabetes and 63.9% for prediabetes. The agreement between HbA1c and diabetes as diagnosed by FPG was moderate (ĸ = 0.498) and low with prediabetes (ĸ = 0.142). The optimal cut-off value for HbA1c to diagnose diabetes was ≥ 6.3% (45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0% (72.8–87.3%), respectively. However, using cut-off value of ≥ 6.5% (48 mmol/mol) improved specificity. At this cut-off value, the sensitivity, specificity and the discriminant ability were 57.4% (44.9–69.0%), 97.1% (96.0–97.9%) and 77.3% (71.0–83.5%). For diagnosing prediabetes with HbA1c between 5.7–6.4% (39–46 mmol/mol), the sensitivity, specificity and the discriminant ability were 62.7% (57.1–67.9%), 56.3% (53.1–59.4%) and 59.5% (56.3–62.5%), respectively. HbA1c at cut-off value of ≥ 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5% and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c and FPG.
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Affiliation(s)
- Akram T. Kharroubi
- Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, Jerusalem, Palestine
- * E-mail:
| | - Hisham M. Darwish
- Faculty of Medicine, Molecular Genetics Laboratory, Al Quds University, Jerusalem, Palestine
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Kilpatrick ES, Bloomgarden ZT. Comment on: Selvin et al. No racial differences in the association of glycated hemoglobin with kidney disease and cardiovascular outcomes. Diabetes Care 2013;36:2995-3001. Diabetes Care 2013; 36:e215. [PMID: 24265384 PMCID: PMC3836117 DOI: 10.2337/dc13-1371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Khan HA, Ola MS, Alhomida AS, Sobki SH, Khan SA. Evaluation of HbA1c criteria for diagnosis of diabetes mellitus: a retrospective study of 12 785 type 2 Saudi male patients. Endocr Res 2013; 39:61-65. [PMID: 24067131 DOI: 10.3109/07435800.2013.828740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recently, American Diabetic Association has recommended glycated hemoglobin (HbA1c ≥6.5%) as an alternate to fasting plasma glucose (FPG ≥7.0 mmol/L) for diagnosis of diabetes. However, studies from different groups showed inconsistent results with the use of HbA1c criteria. We examined the validity of HbA1c cut-point of 6.5% for diagnosis of diabetes. A total of 12 785 male diabetic patients (FGP ≥7.0 mmol/L), aged 56.27 ± 13.32 years were included. The average values of FPG and HbA1c of all the 12 785 patients were 10.127 ± 0.026 mmol/L and 8.729 ± 0.013%, respectively. Sub-grouping of patients into different age categories showed significantly high levels of FPG (10.934 ± 0.123 mmol/L) in the youngest group (age, ≥20-35 years) as compared to FPG (ranged from 10.021 ± 0.052 to 10.190 ± 0.050 mmol/L) in patients with other age categories. The level of HbA1c was highest in the youngest group (8.809 ± 0.056%) and lowest in the oldest group (8.653 ± 0.082%). There was a significant correlation between FPG and HbA1c (R = 0.571, p < 0.001). There were 484 patients below the diagnostic threshold (HbA1c <6.5%), resulting in 3.78% false negative predictions. Majority of the false negative patients were in the age group of 40-75 years and had borderline FPG (7.0-8.0 mmol/L) and HbA1c (6.0-6.5%). These findings suggest that Saudi individuals with HbA1c between 6.0% and 6.5% may be considered as "probable diabetic" and their status should be verified by combined FPG and HbA1c criteria.
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Affiliation(s)
- Haseeb Ahmad Khan
- Department of Biochemistry, College of Science, King Saud University , Riyadh , Saudi Arabia and
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Lalla E, Cheng B, Kunzel C, Burkett S, Lamster I. Dental Findings and Identification of Undiagnosed Hyperglycemia. J Dent Res 2013; 92:888-92. [DOI: 10.1177/0022034513502791] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A change in the American Diabetes Association guidelines added hemoglobin A1c (HbA1c) to the assays for diabetes diagnosis, but evidence suggests that glucose vs. HbA1c criteria may identify different segments of the affected population. We previously demonstrated that oral findings offer an opportunity for the detection of undiagnosed abnormal fasting plasma glucose (FPG) among dental patients who present with diabetes risk factors. In this new cross-sectional study, we sought to extend these observations. The first goal, using data from 591 new participants, was to assess our previously identified hyperglycemia detection models when HbA1c is used for case definition. The second goal, using data from our total cohort of 1,097 participants, was to evaluate the models’ performance regardless of whether an FPG or an HbA1c is used for diagnosis. The presence of ≥ 26% teeth with deep pockets or ≥ 4 missing teeth correctly identified 72% of pre-diabetes or diabetes cases in the HbA1c sample and 75% in the total population. The addition of a point-of-care HbA1c ≥ 5.7% increased correct identification to 87% and 90%, respectively. These results demonstrate the validity of our prediction models regardless of the test used for diabetes or pre-diabetes diagnosis in the clinical setting and underscore the contribution dentists can make.
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Affiliation(s)
- E. Lalla
- Division of Periodontics, College of Dental Medicine
| | - B. Cheng
- Department of Biostatistics, Mailman School of Public Health
| | - C. Kunzel
- Division of Community Health, College of Dental Medicine
| | - S. Burkett
- Division of Periodontics, College of Dental Medicine
| | - I.B. Lamster
- Division of Periodontics, College of Dental Medicine
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
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Hare MJL, Magliano DJ, Zimmet PZ, Söderberg S, Joonas N, Pauvaday V, Larhubarbe J, Tuomilehto J, Kowlessur S, Alberti KGMM, Shaw JE. Glucose-independent ethnic differences in HbA1c in people without known diabetes. Diabetes Care 2013; 36:1534-40. [PMID: 23275368 PMCID: PMC3661823 DOI: 10.2337/dc12-1210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether glucose-independent differences in HbA1c exist between people of African, South Asian, and Chinese ethnicities. RESEARCH DESIGN AND METHODS Data from 6,701 people aged 19-78 years, without known diabetes, from Mauritius, and participating in the population-based Non-Communicable Disease Surveys of the main island and the island of Rodrigues were included. Participants were African (n = 1,219 from main island, n = 1,505 from Rodrigues), South Asian (n = 3,820), and Chinese (n = 157). Survey data included HbA1c, plasma glucose during oral glucose tolerance testing (OGTT), anthropometry, demographics, and medical and lifestyle history. RESULTS Mean HbA1c, after adjustment for fasting and 2-h plasma glucose and other factors known to influence HbA1c, was higher in Africans from Rodrigues (6.1%) than in South Asians (5.7%, P < 0.001), Chinese (5.7%, P < 0.001), or Africans from the main island of Mauritius (5.7%, P < 0.001). The age-standardized prevalence of diabetes among Africans from Rodrigues differed substantially depending on the diagnostic criteria used [OGTT 7.9% (95% CI 5.8-10.0); HbA1c 17.3% (15.3-19.2)]. Changing diagnostic criteria resulted in no significant change in the prevalence of diabetes within the other ethnic groups. CONCLUSIONS People of African ethnicity from Rodrigues have higher HbA1c than those of South Asian or African ethnicity from the main island of Mauritius for reasons not explained by plasma glucose during an OGTT or traditional factors known to affect glycemia. Further research should be directed at determining the mechanism behind this disparity and its relevance to clinical outcomes.
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Venkataraman K, Kao SL, Thai AC, Salim A, Lee JJM, Heng D, Tai ES, Khoo EYH. Ethnicity modifies the relation between fasting plasma glucose and HbA1c in Indians, Malays and Chinese. Diabet Med 2012; 29:911-7. [PMID: 22283416 PMCID: PMC3504343 DOI: 10.1111/j.1464-5491.2012.03599.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/22/2022]
Abstract
AIMS To study whether HbA(1c) , and its relationship with fasting plasma glucose, was significantly different among Chinese, Malays and Indians in Singapore. METHODS A sample of 3895 individuals without known diabetes underwent detailed interview and health examination, including anthropometric and biochemical evaluation, between 2004 and 2007. Pearson's correlation, analysis of variance and multiple linear regression analyses were used to examine the influence of ethnicity on HbA(1c) . RESULTS As fasting plasma glucose increased, HbA(1c) increased more in Malays and Indians compared with Chinese after adjustment for age, gender, waist circumference, serum cholesterol, serum triglyceride and homeostasis model assessment of insulin resistance (P-interaction < 0.001). This translates to an HbA(1c) difference of 1.1 mmol/mol (0.1%, Indians vs. Chinese), and 0.9 mmol/mol (0.08%, Malays vs. Chinese) at fasting plasma glucose 5.6 mmol/l (the American Diabetes Association criterion for impaired fasting glycaemia); and 2.1 mmol/mol (0.19%, Indians vs. Chinese) and 2.6 mmol/mol (0.24%, Malays vs. Chinese) at fasting plasma glucose 7.0 mmol/l, the diagnostic criterion for diabetes mellitus. CONCLUSIONS Using HbA(1c) in place of fasting plasma glucose will reclassify different proportions of the population in different ethnic groups. This may have implications in interpretation of HbA(1c) results across ethnic groups and the use of HbA(1c) for diagnosing diabetes mellitus.
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Affiliation(s)
- K Venkataraman
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
Haemoglobin A(1c) (HbA(1c)) has recently been adopted by the World Health Organization into its recommended criteria for diabetes diagnosis. Much debate continues regarding the relative benefits and potential disadvantages surrounding the use of HbA(1c) for this purpose. There is a lack of consensus as to whether this alteration to the definition of diabetes is a step forward or whether it could add further confusion and ambiguity to the debate on the method and criteria for the diagnosis of this globally important disease. This review provides a comprehensive overview of the current issues surrounding how HbA(1c) is measured and reported; and of the evidence for and against its use in diagnosis.
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Affiliation(s)
- M J L Hare
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.
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Kjome R, Røraas T, Granås A, Sandberg S. Fylkesvise forskjeller i salg av blodglukosestrimler og antidiabetika. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1453-7. [DOI: 10.4045/tidsskr.11.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Soulimane S, Simon D, Shaw JE, Zimmet PZ, Vol S, Vistisen D, Magliano DJ, Borch-Johnsen K, Balkau B. Comparing incident diabetes as defined by fasting plasma glucose or by HbA(1c). The AusDiab, Inter99 and DESIR studies. Diabet Med 2011; 28:1311-8. [PMID: 21824186 DOI: 10.1111/j.1464-5491.2011.03403.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM We examined the ability of fasting plasma glucose and HbA(1c) to predict 5-year incident diabetes for an Australian cohort and a Danish cohort and 6-year incident diabetes for a French cohort, as defined by the corresponding criteria. METHODS We studied 6025 men and women from AusDiab (Australian), 4703 from Inter99 (Danish) and 3784 from DESIR (French), not treated for diabetes and with fasting plasma glucose < 7.0 mmol/l and HbA(1c) < 48 mmol/mol (6.5%) at inclusion. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l and/or treatment for diabetes or as HbA(1c) ≥ 48 mmol/mol (6.5%) and/or treatment for diabetes. RESULTS For AusDiab, incident fasting plasma glucose-defined diabetes was more frequent than HbA(1c) -defined diabetes (P(McNemar)<0.0001), the reverse applied to Inter99 (P(McNemar) < 0.007) and for DESIR there was no difference (P(McNema)=0.17). Less than one third of the incident cases were detected by both criteria. Logistic regression models showed that baseline fasting plasma glucose and baseline HbA(1c) predicted incident diabetes defined by the corresponding criteria. The standardized odds ratios (95% confidence interval) for HbA(1c) were a little higher than for fasting plasma glucose, but not significantly so. They were respectively, 5.0 (4.1-6.1) and 4.1 (3.5-4.9) for AusDiab, 5.0 (3.6-6.8) and 4.8 (3.6-6.3) for Inter99, 4.8 (3.6-6.5) and 4.6 (3.6-5.9) for DESIR. CONCLUSIONS Fasting plasma glucose and HbA(1c) are good predictors of incident diabetes defined by the corresponding criteria. Despite Diabetes Control and Complications Trial-alignment of the three HbA(1c) assays, there was a large difference in the HbA(1c) distributions between these studies, conducted some 10 years ago. Thus, it is difficult to compare absolute values of diabetes prevalence and incidence based on HbA(1c) measurements from that time.
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Affiliation(s)
- S Soulimane
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity and Chronic Kidney Diseases over the Lifecourse, Villejuif Université Paris Sud, UMRS 1018, Villejuif, France.
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Saltevo JT, Kautiainen H, Niskanen L, Oksa H, Puolijoki H, Sundvall J, Keinänen-Kiukaanniemi S, Peltonen M, Tuomilehto J, Uusitupa M, Mäntyselkä P, Vanhala MJ. Ageing and associations of fasting plasma glucose and 2 h plasma glucose with HbA(1C) in apparently healthy population. "FIN-D2D" study. Diabetes Res Clin Pract 2011; 93:344-9. [PMID: 21632144 DOI: 10.1016/j.diabres.2011.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this FIN-D2D cross-sectional survey the relationship of age with HbA(1c) and fasting and 2h glucose in the oral glucose tolerance test (OGTT) was explored in apparently randomly selected healthy population. PATIENTS AND METHODS The glycaemic parameters were measured in 1344 men and 1482 women (aged 45-74 years), and among them we excluded all subjects with known diabetes, hypertension or dyslipidaemia. The final analyses for HbA(1c) and the ratios of fasting glucose/HbA(1c) and 2h glucose/HbA(1c) included 649 men and 804 women. RESULTS Mean age was 57 years and BMI 26.1kg/m(2) for both genders. HbA(1c) increased in both genders with age (p<0.001). For a particular fasting glucose level HbA(1c) level was higher in older age groups (p<0.001 for linearity). By contrast, a particular 2h plasma glucose value in OGTT implied significantly lower HbA(1c) in the elderly (p<0.001 for linearity). CONCLUSION In apparently healthy population, screened with OGTT, in older individuals compared with younger ones a particular HbA(1c) value implies slightly lower fasting glucose, but relatively higher 2h glucose. These results need to be verified in different populations. The effects of age on relation between HbA(1c) and plasma glucose should be taken into account in classifying people into different dysglycaemia categories.
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Affiliation(s)
- J T Saltevo
- Department of Medicine, Central Finland Central Hospital, 40620 Jyväskylä, Finland.
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Nair M, Prabhakaran D, Venkat Narayan K, Sinha R, Lakshmy R, Devasenapathy N, Daniel CR, Gupta R, George PS, Mathew A, Tandon N, Reddy KS. HbA(1c) values for defining diabetes and impaired fasting glucose in Asian Indians. Prim Care Diabetes 2011; 5:95-102. [PMID: 21474403 PMCID: PMC3117965 DOI: 10.1016/j.pcd.2011.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 02/02/2011] [Accepted: 02/16/2011] [Indexed: 02/06/2023]
Abstract
AIM To determine the glycosylated haemoglobin (HbA(1c)) cut-points for diabetes and impaired fasting glucose (IFG) among Asian Indians. METHODS Participants (n=525) were a random sample selected from the India Health Study. Based on history and fasting plasma glucose (FPG), participants were classified into known diabetes, newly diagnosed diabetes (NDD), impaired fasting glucose (IFG) [ADA and WHO criteria] or normal fasting glucose (NFG). Receiver Operating Characteristic curves were used to identify the optimum sensitivity and specificity for defining HbA(1c) cut-points for NDD and IFG against the FPG criteria. RESULTS There were 64 participants with a known history of diabetes. Of the remaining 461, IFG was present in 44.7% (ADA) and 18.2% (WHO), and 10.4% were NDD. Mean HbA(1c) were 5.4 (±0.04)% for NFG; 5.7 (±0.06)% among IFG-ADA, 5.8 (±0.09)% among IFG-WHO; 7.5 (±0.33)% for NDD and 8.4 (±0.32)% for known diabetes. Optimal HbA(1c) cut-point for NDD was 5.8% (sensitivity=75%, specificity=75.5%, AUC=0.819). Cut-point for IFG (ADA) was 5.5% (sensitivity=59.7%, specificity=59.9%, AUC=0.628) and for IFG (WHO) was 5.6% (sensitivity=60.7%, specificity=65.1%, AUC=0.671). CONCLUSION In this study population from north and south regions of India, the HbA(1c) cut-point that defines NDD (≥5.8%) was much lower than that proposed by an international expert committee and the American Diabetes Association (≥6.5%). A cut-point of ≥5.5% or ≥5.6% defined IFG, and was slightly lower than the ≥5.7% for high risk proposed, but accuracy was less than 70%.
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Affiliation(s)
- Manisha Nair
- Fogarty International Centre & Centre of Excellence-Centre for Cardiometabolic Risk Reduction in South Asia, Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India
| | | | - Rashmi Sinha
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD, USA
| | - Ramakrishna Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Carrie R. Daniel
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD, USA
| | - Ruby Gupta
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Nikhil Tandon
- Dept of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Mostafa SA, Khunti K, Srinivasan BT, Webb D, Davies MJ. Detecting Type 2 diabetes and impaired glucose regulation using glycated hemoglobin in different populations. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/dmt.10.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cohen RM, Haggerty S, Herman WH. HbA1c for the diagnosis of diabetes and prediabetes: is it time for a mid-course correction? J Clin Endocrinol Metab 2010; 95:5203-6. [PMID: 21131541 PMCID: PMC2999978 DOI: 10.1210/jc.2010-2352] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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