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  • Wade, Alisha N.MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa (author)

Concordance between fasting plasma glucose and HbA1c in the diagnosis of diabetes in black South African adults: A cross-sectional study

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-06-17
  • BMJ Publishing Group Ltd,2021
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:umu-185325
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-185325URI
  • https://doi.org/10.1136/bmjopen-2020-046060DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Objectives: We investigated concordance between haemoglobin A1c (HbA1c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity.Design: Cross-sectional study.Setting: Rural South African population-based cohort.Participants: 765 black individuals aged 40–70 years and with no history of diabetes.Primary and secondary outcome measures:  The primary outcome measure was concordance between HbA1c-defined diabetes and FPG-defined diabetes. Secondary outcome measures were differences in anthropometric characteristics, fat distribution and insulin resistance (measured using Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR)) between those with concordant and discordant HbA1c/FPG classifications and predictors of HbA1c variance.Results: The prevalence of HbA1c-defined diabetes was four times the prevalence of FPG-defined diabetes (17.5% vs 4.2%). Classification was discordant in 15.7% of participants, with 111 individuals (14.5%) having HbA1c-only diabetes (kappa 0.23; 95% CI 0.14 to 0.31). Median body mass index, waist and hip circumference, waist-to-hip ratio, subcutaneous adipose tissue and HOMA-IR in participants with HbA1c-only diabetes were similar to those in participants who were normoglycaemic by both biomarkers and significantly lower than in participants with diabetes by both biomarkers (p<0.05). HOMA-IR and fat distribution explained additional HbA1c variance beyond glucose and age only in women.Conclusions: Concordance was poor between HbA1c and FPG in diagnosis of diabetes in black South Africans, and participants with HbA1c-only diabetes phenotypically resembled normoglycaemic participants. Further work is necessary to determine which of these parameters better predicts diabetes-related morbidities in this population and whether a population-specific HbA1c threshold is necessary.

Subject headings and genre

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  • Crowther, Nigel J.Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa (author)
  • Abrahams-Gessel, ShafikaCentre for Health Decision Science, Harvard University T H Chan School of Public Health, MA, Boston, United States (author)
  • Berkman, LisaHarvard Centre for Population and Development Studies, Harvard University T H Chan School of Public Health, MA, Boston, United States (author)
  • George, Jaya A.Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa (author)
  • Gómez-Olivé, F. XavierMRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa (author)
  • Manne-Goehler, JenniferDivision of Infectious Diseases, Massachusetts General Hospital, MA, Boston, United States (author)
  • Salomon, Joshua A.Centre for Health Policy, Stanford University, CA, Stanford, United States (author)
  • Wagner, Ryan G.MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa (author)
  • Gaziano, Thomas A.Centre for Health Decision Science, Harvard University T H Chan School of Public Health, MA, Boston, United States; Division of Cardiovascular Medicine, Brigham and Women’s Hospital, MA, Boston, United States (author)
  • Tollman, Stephen M.Umeå universitet,Institutionen för epidemiologi och global hälsa,Institutionen för folkhälsa och klinisk medicin,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana(Swepub:umu)stto0004 (author)
  • Cappola, Anne R.Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, PA, Philadelphia, United States (author)
  • MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa (creator_code:org_t)

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  • In:BMJ Open: BMJ Publishing Group Ltd11:62044-6055

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