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Moving to an A1C-Based Diagnosis of Diabetes Has a Different Impact on Prevalence in Different Ethnic Groups
Open accessAbstract
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 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]
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“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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Citations
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The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives
Chen, L., Magliano, D. J., & Zimmet, P. Z. (2012) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.183 · Cited by 2,227
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Metadata
- 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
- 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
- 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
- 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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