title: Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study.
abstract: Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes.
authors.affiliation: Division of Diabetes and Nutritional Sciences, King's College London, Diabetes Research Group, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Azam
authors.affiliation: Department of Psychological Medicine, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Marwood
authors.affiliation: Department of Psychological Medicine, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Khalida
authors.initials: K
authors.lastname: Ismail
authors.affiliation: Paxton Green Group Practice, 1 Alleyn Park, London SE21 8AU, UK.
authors.forename: Tyrrell
authors.initials: T
authors.lastname: Evans
authors.affiliation: Department of Ophthalmology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9PJ, UK.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.affiliation: Department of Psychological Medicine, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Winkley
authors.affiliation: Division of Diabetes and Nutritional Sciences, King's College London, Diabetes Research Group, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
authors.forename: Stephanie Anne
authors.initials: SA
authors.lastname: Amiel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000378:metabolism*; D044383:Black People / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D012923:Social Class; D044465:White People / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human