Moving to an A1C-Based Diagnosis of Diabetes Has a Different Impact on Prevalence in Different Ethnic Groups

Christensen, Dirk L.; Witte, Daniel R.; Kaduka, Lydia; Jørgensen, Marit E.; Borch-Johnsen, Knut; Mohan, Viswanathan; Shaw, Jonathan E.; Tabák, Adam G.; Vistisen, Dorte

doi:10.2337/dc09-1843

Cited by 182Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchDiabetes and associated disorders

Moving to an A1C-Based Diagnosis of Diabetes Has a Different Impact on Prevalence in Different Ethnic Groups

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Christensen, Dirk L., Witte, Daniel R., Kaduka, Lydia, Jørgensen, Marit E., Borch-Johnsen, Knut, Mohan, Viswanathan, Shaw, Jonathan E., Tabák, Adam G. +1 more·2010·Diabetes Care

DOI 10.2337/dc09-1843PMC PMC2827511

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Abstract

OBJECTIVE: To compare screen-detected diabetes prevalence and the degree of diagnostic agreement by ethnicity with the current oral glucose tolerance test (OGTT)-based and newly proposed A1C-based diagnostic criteria. RESEARCH DESIGN AND METHODS: Six studies (1999–2009) from Denmark, the U.K., Australia, Greenland, Kenya, and India were tested for the probability of an A1C ≥6.5% among diabetic case subjects based on an OGTT. The difference in probability between centers was analyzed by logistic regression adjusting for relevant confounders. RESULTS: Diabetes prevalence was lower with the A1C-based diagnostic criteria in four of six studies. The probability of an A1C ≥6.5% among OGTT-diagnosed case subjects ranged widely (17.0–78.0%) by study center. Differences in diagnostic agreement between ethnic subgroups in the U.K. study were of the same magnitude as between-country comparisons. CONCLUSIONS: A shift to an A1C-based diagnosis for diabetes will have substantially different consequences for diabetes prevalence across ethnic groups and populations.

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The IEC A1C criteria have recently been compared with testing with fasting glucose or OGTTs in various populations to diagnose diabetes and high-risk/pre-diabetes.
“The IEC A1C criteria have recently been compared with testing with fasting glucose or oral glucose tolerance tests (OGTTs) in various populations to diagnose diabetes (7–13) and high-risk/pre-diabetes (10,11,13), but the ADA A1C criteria have not been studied.”
From Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria (2010) · cites this paper as [9]
Problems with the IEC criteria have been reported with diverse populations.
“Further studies would be required before our findings with the ADA criteria could be generalized to other racial/ethnic groups, but problems with the IEC criteria have been reported with diverse populations (8,9,12).”
From Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria (2010) · cites this paper as [9]

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Moving to an A1c-based diagnosis of diabetes has a different impact on prevalence in different ethnic groups. Diabetes care
Christensen, D. L., Witte, D. R., Kaduka, L. U., Jørgensen, M. E., Shaw, J. E., & Tabák, Á. G. (2010)
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HbA1c-based diagnosis of diabetes: ethnic disparities in prevalence effects
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Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria
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Corresponding author:
Christensen, D. L., Phd, M., Witte, D. R., Phd, M., Kaduka, L. U., Marit, E., & Vistisen, D. (2009)
Self-citation
Career opportunities
(2009) · Journal of the National Medical Association · doi:10.1016/s0027-9684(15)30966-4

Authors: Christensen, D. L., Witte, D. R., Kaduka, L., Jørgensen, M. E., Borch-Johnsen, K., Mohan, V., Shaw, J. E., Tabák, A. G., & Vistisen, D.
Affiliations: University of Copenhagen (DK)
Novo Nordisk (Denmark) (DK)
Kenya Medical Research Institute (KE)
University of Southern Denmark (DK)
Steno Diabetes Center, Gentofte, Denmark;
Madras Diabetes Research Foundation (IN)
Baker Heart and Diabetes Institute (AU)
Department of Epidemiology and Public Health, University College London, London, U.K.;
Corresponding author: Vistisen, Dorte
ORCID: Christensen, Dirk L.
Witte, Daniel R.
Kaduka, Lydia
Jørgensen, Marit E.
Mohan, Viswanathan
Shaw, Jonathan E.
Vistisen, Dorte
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2009-12-15
Volume: 33
Issue: 3
Pages: 580-582
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc09-1843
PMC: PMC2827511
OpenAlex: W1989690440
Cited by: 182
References: 11
Citations by year: 2026: 4 · 2025: 1 · 2024: 7 · 2023: 3 · 2022: 1 · 2021: 10 · 2020: 5 · 2019: 7 · 2018: 6 · 2017: 7 · 2016: 16 · 2015: 12 · 2014: 19 · 2013: 13 · 2012: 22
FWCI: 17.24
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 4278 d)
Locations: Diabetes Care (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders: British Heart Foundation
National Institute on Aging (AG 13196, R37AG013196, R01AG013196)
National Heart, Lung, and Blood Institute (HL36310, R01HL036310)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords: diabetes diagnosis, HbA1c, oral glucose tolerance test, diagnostic criteria, diabetes prevalence, ethnic differences, diagnostic agreement, screening, cross-national comparison
MeSH terms: Adult, Aged, Australia, Denmark, Diabetes Mellitus, Diagnostic Techniques, Endocrine, Ethnicity, Female, United Kingdom, Greenland, Glycated Hemoglobin, Humans, India, Kenya, Male, Middle Aged, Confounding Factors, Epidemiologic, Prevalence

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Moving to an A1C-Based Diagnosis of Diabetes Has a Different Impact on Prevalence in Different Ethnic Groups

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