title: Diagnostic accuracy of glycated hemoglobin compared with oral glucose tolerance test for diagnosing diabetes mellitus in Chinese adults: a meta-analysis.
abstract: OBJECTIVE
  A meta-analysis was conducted to evaluate the diagnostic value of glycated hemoglobin (HbA1c) ≥6.5% (48mmol/mol) for diabetes in Chinese adults.
  
  
  METHODS
  Oral glucose tolerance test (OGTT) was selected as the reference standard. PubMed, EMBASE, CNKI, Wanfang Data, and VIP were searched to obtain all diagnostic tests with HbA1c ≥6.5% (48mmol/mol) for diabetes in Chinese adults published between January 2003 and October 2013. The qualities of the included studies were assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-DiSc software was used to conduct a comprehensive quantitative assessment, and summary receiver operating characteristic (sROC) curves were obtained.
  
  
  RESULTS
  A total of 9 studies with 25,932 subjects were included. Pooled sensitivity was 0.518, pooled specificity 0.956, pooled positive likelihood ratio 19.007 and pooled negative likelihood ratio was 0.477. Pooled diagnostic odds ratio was 40.631. AUCsROC was 0.929.
  
  
  CONCLUSIONS
  Compared with OGTT, using HbA1c ≥6.5% (48mmol/mol) to diagnose diabetes in Chinese adults exhibited high specificity and low sensitivity and would have failed to diagnose 48.7% of newly diagnosed diabetes. The diagnostic HbA1c value could be reduced to improve sensitivity. Long-term prospective studies are required to establish an appropriate HbA1c value as a diagnostic criterion for diabetes in China.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Information Center, Tianjin Centers for Disease Control and Prevention, Tianjin, China.
authors.forename: Na
authors.initials: N
authors.lastname: Xu
authors.affiliation: Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital and Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Hongfang
authors.initials: H
authors.lastname: Wu
authors.affiliation: Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital and Institute of Endocrinology, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Daiqing
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China. Electronic address: wzhzy2002@163.com.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D044466:Asian People; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine; D005951:Glucose Tolerance Test / Q000379:methods*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans
chemical_list: D006442:Glycated Hemoglobin
keywords: Diabetes; Diagnostic evaluation; HbA1c; OGTT