Plasma glucose and hemoglobin A1c for the detection of diabetes in Chinese adults.
BACKGROUND
The aim of the present study was to evaluate the performance of plasma glucose (PG) and HbA1c for the detection of diabetes in the general population in China.


METHODS
A cross-sectional analysis was conducted in a nationally representative sample of 98,658 Chinese adults aged ≥18 years. Fasting plasma glucose and HbA1c levels were measured in all participants after at least a 10-h overnight fast. An oral glucose tolerance test (OGTT) was conducted among participants without a self-reported history of diagnosed diabetes.


RESULTS
An HbA1c ≥6.5% could identify 4.57% of Chinese adults as having newly detected diabetes, followed by fasting PG (FPG) and 2-h PG at 4.52% and 3.50%, respectively. Approximately 1.95% of the total population was detected by HbA1c but not by FPG or 2-h PG. However, FPG plus HbA1c could identify most (85.2%) diabetic individuals identified by any of the three tests (i.e., FPG, 2-h PG, and HbA1c). Levels of most cardiovascular risk factors, such as body mass index, waist circumference, and cholesterol, were higher in diabetes detected by HbA1c alone than in diabetes identified by the OGTT.


CONCLUSIONS
Although HbA1c ≥6.5% has been recommended by the American Diabetes Association as one of the diagnostic tests for diabetes, caution should be used to avoid potential overdiagnosis when interpreting diabetes identified by elevated HbA1c alone.
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Yu
Y
Xu
Chinese Center for Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Wenhua
W
Zhao
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Weiqing
W
Wang
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Yufang
Y
Bi
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Jianhong
J
Li
Chinese Center for Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.|Department of Food Science, College of Applied Art and Science, Beijing Union University, Beijing, China.
Shengquan
S
Mi
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Min
M
Xu
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Jieli
J
Lu
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Tiange
T
Wang
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Mian
M
Li
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Zhuoqun
Z
Wang
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Yong
Y
Jiang
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Limin
L
Wang
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Linhong
L
Wang
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Meng
M
Dai
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Di
D
Zhang
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Shenghan
S
Lai
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, the National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Guang
G
Ning
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002681:China; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000378:metabolism; D005215:Fasting / Q000502:physiology; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
D001786:Blood Glucose; D006442:Glycated Hemoglobin
HA1c; HbA1c; diabetes; plasma glucose; 糖尿病; 血糖