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Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore.
Sci Rep. 2018 08 20; 8(1):12419.SR

Abstract

The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes.

Authors+Show Affiliations

Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.Epidemiology & Disease Control Division, Ministry of Health, Singapore, Singapore.Public Health Group, Ministry of Health, Singapore, Singapore.Department of Medicine, National University Hospital, Singapore, Singapore.Department of Medicine, National University Hospital, Singapore, Singapore.Department Laboratory Medicine, National University Hospital, Singapore, Singapore. tploh@hotmail.com. Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore, Singapore. tploh@hotmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30127499

Citation

Lim, Wei-Yen, et al. "Screening for Diabetes With HbA1c: Test Performance of HbA1c Compared to Fasting Plasma Glucose Among Chinese, Malay and Indian Community Residents in Singapore." Scientific Reports, vol. 8, no. 1, 2018, p. 12419.
Lim WY, Ma S, Heng D, et al. Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Sci Rep. 2018;8(1):12419.
Lim, W. Y., Ma, S., Heng, D., Tai, E. S., Khoo, C. M., & Loh, T. P. (2018). Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. Scientific Reports, 8(1), 12419. https://doi.org/10.1038/s41598-018-29998-z
Lim WY, et al. Screening for Diabetes With HbA1c: Test Performance of HbA1c Compared to Fasting Plasma Glucose Among Chinese, Malay and Indian Community Residents in Singapore. Sci Rep. 2018 08 20;8(1):12419. PubMed PMID: 30127499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for diabetes with HbA1c: Test performance of HbA1c compared to fasting plasma glucose among Chinese, Malay and Indian community residents in Singapore. AU - Lim,Wei-Yen, AU - Ma,Stefan, AU - Heng,Derrick, AU - Tai,E Shyong, AU - Khoo,Chin Meng, AU - Loh,Tze Ping, Y1 - 2018/08/20/ PY - 2018/03/22/received PY - 2018/07/16/accepted PY - 2018/8/22/entrez PY - 2018/8/22/pubmed PY - 2019/10/28/medline SP - 12419 EP - 12419 JF - Scientific reports JO - Sci Rep VL - 8 IS - 1 N2 - The prevalence of diabetes in Singapore is high. Screening to facilitate early detection and intervention has been shown to be cost-effective. Current clinical practice guidelines in Singapore recommend screening with fasting plasma glucose (FPG), followed by an oral glucose tolerance test (OGTT) in those with FPG 6.1-6.9 mmol/L. Glycated haemoglobin A1c (HbA1c) has robust stability at ambient temperature, and can be performed on non-fasted capillary blood samples, making it an attractive potential alternative for screening. However, limitations of HbA1c include differential performance in different races, and its performance as a screening test has not been well characterized in Asian populations. This study compares HbA1c and FPG as diabetes screening modalities in 3540 community-dwelling Singapore residents of Chinese, Malay and Indian race to detect diabetes mellitus diagnosed based on blood glucose (FPG ≥ 7.0 mmol/L, 2 hr OGTT ≥ 11.1 mmol/L). The area under the receiver-operating-characteristic curve (AUC) was higher for FPG compared to HbA1c in the overall population and age, race and age-race strata, but these differences were not statistically significant. HbA1c > = 7.0% identified 95% of individuals with diabetes mellitus, and the remainder had impaired glucose tolerance (IGT). HbA1c cut-off at 6.1% had better sensitivity (0.825) to FPG at 6.1 mmol/L. The positive predictive value of HbA1c at 6.1% was 40-50% in different age-race combinations with a negative predictive value of about 98%. If follow-up screening with FPG is used, a lower cut-off at 5.6 mmol/L is appropriate in identifying people with pre-diabetes, as about 85% of people with HbA1c 6.1-6.9% and FPG 5.6-6.9 mmol/L had IFG/IGT or diabetes in the study sample. HbA1c is an appropriate alternative to FPG as a first-step screening test, and the combination of Hba1c > = 6.1% and FPG > = 5.6 mmol/L would improve the identification of individuals with diabetes mellitus and prediabetes. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/30127499/Screening_for_diabetes_with_HbA1c:_Test_performance_of_HbA1c_compared_to_fasting_plasma_glucose_among_Chinese_Malay_and_Indian_community_residents_in_Singapore_ L2 - https://doi.org/10.1038/s41598-018-29998-z DB - PRIME DP - Unbound Medicine ER -