title: Diagnostic accuracy of HbA1c in diabetes between Eastern and Western.
abstract: BACKGROUND
  In 2010, the American Diabetes Association recommended the use of HbA1c as a diagnostic criterion for diabetes. However, HbA1c is not an accepted diagnostic tool for diabetes in Eastern Asia, because genetic differences compromise the standardization of the diagnostic cut-off point.
  
  
  OBJECTIVE
  This study evaluated differences in the use of HbA1c for diagnosing diabetes in Eastern and Western populations and investigated whether HbA1c cut-off point of ≥ 6.5% is diagnostic of diabetes in patients from Eastern Asia.
  
  
  METHODS
  Literature was obtained from MEDLINE, EMBASE and Cochrane databases. The pooled sensitivity and specificity of each HbA1c cut-off point were extracted and compared between Western and Eastern populations. Differences in the cut-off point for diagnosing diabetes in each region were compared by examining differences in the area under summary receiver operating characteristic (SROC) curves.
  
  
  RESULTS
  Twelve publications from Eastern countries (n = 59,735) and 13 from Western countries (n = 22,954) were included in the analysis. Areas under SROC curves in the Eastern and Western groups were 0.9331 and 0.9120, respectively (P = 0.98). The cut-off point of the highest Youden index was 6.0%. At the HbA1c cut-off point of 6.5%, the pooled sensitivity and specificity were 58.7% and 98.4% for Eastern countries and 65.5% and 98.1% for Western countries, respectively.
  
  
  CONCLUSIONS
  HbA1c exhibits the same diagnostic value for diabetes in Eastern and Western populations. In both populations, HbA1c levels > 6.0% identify the population at high risk of diabetes, and HbA1c > 6.5% is diagnostic of clinically established diabetes.
authors: Department of Endocrinology and Metabolism Disease, The 4th Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
authors: Shuang
authors: S
authors: Yan
authors: Siying
authors: S
authors: Liu
authors: Yashuang
authors: Y
authors: Zhao
authors: Wencui
authors: W
authors: Zhang
authors: Xiaohui
authors: X
authors: Sun
authors: Jianing
authors: J
authors: Li
authors: Fuli
authors: F
authors: Jiang
authors: Jiaming
authors: J
authors: Ju
authors: Ning
authors: N
authors: Lang
authors: Yingqi
authors: Y
authors: Zhang
authors: Weiyu
authors: W
authors: Zhou
authors: Qiang
authors: Q
authors: Li
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005202:Asia, Eastern; D005215:Fasting / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human