Discrepancies Between the Glycated Hemoglobin Criteria and Glucose-Based Criteria for Diagnosis of Diabetes and Prediabetes — ASN Events
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Discrepancies Between the Glycated Hemoglobin Criteria and Glucose-Based Criteria for Diagnosis of Diabetes and Prediabetes (#294)

Raj Shrestha 1 , Prabin Gyawali 1 , Eans Tara Dr. Tuladhar 2 , Bharat Prof. Jha 2
  1. Dhulikhel Hospital-Kathmandu University Teaching Hospital, Kathmandu, BAGMATI, Nepal
  2. Department of Biochemistry, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal

AIMS AND RATIONALE

The number of the people with type 2 diabetes is increasing in every country; therefore there is an increasing need to identify diabetes earlier and more efficiently. Nearly 80% of people with diabetes live in low and middle income countries (LMICs). Traditionally, we have relied on glucose based criteria (fasting, postprandial & random) to make the diagnosis of diabetes; however, glycated hemoglobin (HbA1c) has recently been endorsed as a diagnostic test, as superior alternative to glucose-based criteria. Although, it is still controversy about implementation of HbA1c criteria in LMICs especially due to several cons one of them being high cost. Similarly previous studies have suggested that some degree of discrepancies may exist between the HbA1c and glucose based criteria and may vary by race, ethnicity, sex, and age in various populations. Hence, we aimed to access the discrepancies between the new HbA1c-based criteria over glucose-based criteria for diagnosis of diabetes and pre-diabetes among clinically diagnosed Nepalese population.

METHODS

A total of 1277 clinically suspected type II diabetes and prediabetes, who attended Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal between January 2012 and April 2014 were recruited in the study. Initial screening was carried out using the FINDRISC questionnaire. The American Diabetes Association (ADA)-glucose based and ADA HbA1c criterion were used to diagnose diabetes and pre-diabetes. The discrepancies between two criteria to diagnose pre-diabetes and diabetes were evaluated. The statistical analysis was done by SPSS statistical package version 17.0.

FINDINGS

Out of total subjects, 901 subjects were found to be diabetes and among them 779 (88.34 %) meet ADA-glucose based criteria while 805 (89.34%) meet ADA-HbA1c based criteria to be diagnosed as diabetes. The discrepancy between the HbA1c criterion over glucose criteria was 11.65%. Moreover, 459 subjects were found to be prediabetes with glucose based criteria while 335 were prediabetes based in HbA1c criteria demonstrating significant discrepancies.

POTENTIAL USES OF THIS RESEARCH

Significant discrepancies exist between the HbA1c- and glucose-based criteria for diagnosis of diabetes in Nepalese population. Furthermore, the substantial numbers of subjects with pre-diabetes were missed by HbA1c criterion.