title: Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion.
abstract: OBJECTIVE
  The prevalence of diabetes mellitus among Malaysians aged ≥ 30 years of age has increased by more than twofold over a 20-year period. This study aimed to determine the current status and to evaluate the diagnostic usefulness of the HbA(1c) cut-off point of 48 mmol/mol (6.5%).
  
  
  METHODS
  Using a two-stage stratified sampling design, participants aged ≥ 18 years were recruited from five zones selected to represent Malaysia. An oral glucose tolerance test was performed on all those not known to have diabetes.
  
  
  RESULTS
  A total of 4341 subjects were recruited. By World Health Organization criteria, the prevalence of diabetes mellitus was 22.9%; of that percentage, 10.8% was known diabetes and 12.1% was newly diagnosed diabetes. Diabetes was most prevalent amongst Indians (37.9%) and Malays (23.8%). Prevalence of new diabetes mellitus was only 5.5% (95% CI 4.9-6.3) when based on the HbA(1c) diagnostic criteria of 48 mmol/mol (6.5%) and, although the cut-off point was highly specific (98.1%), it was less sensitive (36.7%) compared with 45 mmol/mol (6.3%), which showed the optimal sum of sensitivity (42.5%) and specificity (97.4%) in identifying new diabetes mellitus.
  
  
  CONCLUSIONS
  This study recorded an overall diabetes prevalence of 22.6%, almost a twofold increase from 11.6% reported in 2006. This was likely attributable to the higher prevalence of new diabetes (12.1%) diagnosed following an oral glucose tolerance test. An HbA(1c) of 45 mmol/mol (6.3%) was found to be a better predictive cut-off point for detecting new diabetes in our multi-ethnic population.
authors: Cardiovascular, Diabetes and Nutrition Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia. nazaimoon@imr.gov.my
authors: W M
authors: WM
authors: Wan Nazaimoon
authors: S H
authors: SH
authors: Md Isa
authors: W B
authors: WB
authors: Wan Mohamad
authors: A S
authors: AS
authors: Khir
authors: N A
authors: NA
authors: Kamaruddin
authors: I M
authors: IM
authors: Kamarul
authors: N
authors: N
authors: Mustafa
authors: I S
authors: IS
authors: Ismail
authors: O
authors: O
authors: Ali
authors: B A K
authors: BA
authors: Khalid
mesh_terms: D000328:Adult; D002681:China / Q000208:ethnology; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity; D014944:World Health Organization
chemical_list: D006442:Glycated Hemoglobin