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

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dc.contributor.author Danaei, G.
dc.contributor.author Fahimi, S.
dc.contributor.author Lu, Y.
dc.contributor.author Zhou, B.
dc.contributor.author Hajifathalian, K.
dc.contributor.author Cesare, M.D.
dc.contributor.author Lo, W.-C.
dc.contributor.author Reis-Santos, B.
dc.contributor.author Cowan, M.J.
dc.contributor.author Shaw, J.E.
dc.contributor.author Bentham, J.
dc.contributor.author Lin, J.K.
dc.contributor.author Bixby, H.
dc.contributor.author Magliano, D.
dc.contributor.author Bovet, P.
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Khang, Y.-H.
dc.contributor.author Stevens, G.A.
dc.contributor.author Riley, L.M.
dc.contributor.author Ali, M.K.
dc.contributor.author Ezzati, M.
dc.contributor.author Kadir, K.A.
dc.contributor.author Abu-Rmeileh, N.M.
dc.contributor.author Acosta-Cazares, B.
dc.contributor.author Aekplakorn, W.
dc.contributor.author Aguilar-Salinas, C.A.
dc.contributor.author Ahmadvand, A.
dc.contributor.author Nsour, M.A.
dc.contributor.author Alkerwi, A.
dc.contributor.author Amouyel, P.
dc.contributor.author Andersen, L.B.
dc.contributor.author Anderssen, S.A.
dc.contributor.author Andrade, Dolores S.
dc.contributor.author Anjana, R.M.
dc.contributor.author Aounallah-Skhiri, H.
dc.contributor.author Aris, T.
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dc.contributor.author Alberto Barceló
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dc.contributor.author Baur, L.A.
dc.contributor.author Romdhane, H.B.
dc.contributor.author Bernabé Ortiz, Antonio
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dc.contributor.author Blokstra, A.
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dc.contributor.author Brewster, L.M.
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dc.contributor.author de León, A.C.
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dc.date.accessioned 2019-02-22T14:54:05Z
dc.date.available 2019-02-22T14:54:05Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5624
dc.description.abstract Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet. Diabetes and Endocrinology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject diabetes mellitus en_US
dc.subject Sensitivity and Specificity en_US
dc.subject Global Health en_US
dc.subject Prevalence en_US
dc.subject Diabetes Mellitus en_US
dc.subject Blood Glucose en_US
dc.subject income en_US
dc.subject body mass en_US
dc.subject Biomarkers en_US
dc.subject age en_US
dc.subject human en_US
dc.subject adult en_US
dc.subject female en_US
dc.subject health en_US
dc.subject male en_US
dc.subject Article en_US
dc.subject priority journal en_US
dc.subject prevalence en_US
dc.subject blood en_US
dc.subject metabolism en_US
dc.subject sensitivity and specificity en_US
dc.subject biological marker en_US
dc.subject diagnostic test accuracy study en_US
dc.subject health survey en_US
dc.subject hemoglobin A1c en_US
dc.subject oral glucose tolerance test en_US
dc.subject geography en_US
dc.subject glycosylated hemoglobin en_US
dc.subject glucose en_US
dc.subject glucose blood level en_US
dc.subject economic aspect en_US
dc.subject glucose tolerance test en_US
dc.subject Glucose Tolerance Test en_US
dc.subject false positive result en_US
dc.subject Hemoglobin A, Glycosylated en_US
dc.subject population group en_US
dc.subject gross national product en_US
dc.subject high income region en_US
dc.subject sentinel surveillance en_US
dc.subject Sentinel Surveillance en_US
dc.title Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S2213-8587(15)00129-1
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.18
dc.relation.issn 2213-8595

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