title: A1C as a diagnostic criteria for diabetes in low- and middle-income settings: evidence from Peru.
abstract: OBJECTIVE
  To determine the prevalence of type 2 diabetes mellitus, in three groups of Peruvian adults, using fasting glucose and glycosylated hemoglobin (A1C).
  
  
  RESULTS
  This study included adults from the PERU MIGRANT Study who had fasted ≥ 8 h. Fasting glucose ≥ 126 mg/dL and A1C ≥ 6.5% were used, separately, to define diabetes. Subjects with a current diagnosis of diabetes were excluded. 964 of 988 subjects were included in this analysis. Overall, 0.9% (95%CI 0.3-1.5) and 3.5% (95%CI 2.4-4.7) had diabetes using fasting glucose and A1C criteria, respectively. Compared to those classified as having diabetes using fasting glucose, newly classified subjects with diabetes using A1C (n = 25), were older, poorer, thinner and more likely to come from rural areas. Of these, 40% (10/25) had impaired fasting glucose (IFG).
  
  
  CONCLUSIONS
  This study shows that the use of A1C as diagnostic criteria for type 2 diabetes mellitus identifies people of different characteristics than fasting glucose. In the PERU MIGRANT population using A1C to define diabetes tripled the prevalence; the increase was more marked among poorer and rural populations. More than half the newly diagnosed people with diabetes using A1C had normal fasting glucose.
authors.affiliation: CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. Jaime.Miranda@upch.pe
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.forename: Sanja
authors.initials: S
authors.lastname: Stanojevic
authors.forename: German
authors.initials: G
authors.lastname: Malaga
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D004641:Emigration and Immigration; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010568:Peru
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin