title: Erroneous inflation of diabetes prevalence: Are there global implications?
abstract: Comparison of the prevalence of type 2 diabetes mellitus (T2DM) in adults aged 25-64 years in selected Pacific Island countries using whole blood and plasma glucose cut-off points. Unit records of STEPwise approach to Surveillance (STEPS) surveys obtained from Fiji, Samoa, and Tonga Ministries of Health; T2DM prevalence recalculated using whole blood and plasma cut-off points. Shaded bars indicate T2DM prevalence based on correct glucose cut-off points for the glucose meter used (fasting blood glucose [FBG] ≥6.1 mmol/L for early surveys1,3,5; fasting plasma glucose [FPG] ≥7.0 mmol/L for later surveys),2,4,6whereas open bars show T2DM prevalence based on incorrect glucose cut-off points (FPG ≥6.1 mmol/L for later surveys).2,4,6Highlights Incorrect glucose cut-off points were applied to the Fiji 2011, Samoa 2013, and Tonga 2012 STEPS surveys. This doubled the actual T2DM prevalences compared to using the correct glucose cut-off points. The errors occurred due to modern glucose meters producing measurements in plasma-equivalent concentrations from whole blood samples. The incorrect whole blood glucose cut-off (≥6.1mmol/L) was applied instead of the correct plasma glucose cut-off (≥7.0mmol/L). This error likely affects other Pacific states, and may have global ramifications.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia. r.taylor@unsw.edu.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.|Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Zimmet
authors.affiliation: Ministry of Health, Apia, Samoa.
authors.forename: Take
authors.initials: T
authors.lastname: Naseri
authors.affiliation: Ministry of Health, Nuku'alofa, Tonga.
authors.forename: Sione
authors.initials: S
authors.lastname: Hufanga
authors.affiliation: Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Isimeli
authors.initials: I
authors.lastname: Tukana
authors.affiliation: Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Sophia
authors.initials: S
authors.lastname: Lin
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Linhart
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morrell
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D014943:Global Health; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose
keywords: blood glucose; diabetes mellitus; measurement; pacific islands; prevalence