Please use this identifier to cite or link to this item: https://doi.org/10.1210/jc.2014-2498
Title: Diagnosis of Diabetes Mellitus Using HbA1c in Asians: Relationship Between HbA1c and Retinopathy in a Multiethnic Asian Population
Authors: Sabanayagam, Charumathi 
Khoo, Eric YH 
Lye, Weng Kit 
Ikram, M Kamran 
Lamoureux, Ecosse L 
Cheng, Ching Yu 
Tan, Maudrene LS 
Salim, Agus 
Lee, Jeannette 
Lim, Su-Chi 
Tavintharan, Subramaniam
Thai, Ah-Chuan 
Heng, Derrick
Ma, Stefan
Tai, E Shyong 
Wong, Tien Y 
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
GLYCATED HEMOGLOBIN
ETHNIC-DIFFERENCES
FASTING GLUCOSE
HBA(1C) LEVELS
BLOOD-GLUCOSE
EYE DISEASES
A1C
A(1C)
ASSOCIATION
METHODOLOGY
Issue Date: 1-Feb-2015
Publisher: ENDOCRINE SOC
Citation: Sabanayagam, Charumathi, Khoo, Eric YH, Lye, Weng Kit, Ikram, M Kamran, Lamoureux, Ecosse L, Cheng, Ching Yu, Tan, Maudrene LS, Salim, Agus, Lee, Jeannette, Lim, Su-Chi, Tavintharan, Subramaniam, Thai, Ah-Chuan, Heng, Derrick, Ma, Stefan, Tai, E Shyong, Wong, Tien Y (2015-02-01). Diagnosis of Diabetes Mellitus Using HbA1c in Asians: Relationship Between HbA1c and Retinopathy in a Multiethnic Asian Population. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM 100 (2) : 689-696. ScholarBank@NUS Repository. https://doi.org/10.1210/jc.2014-2498
Abstract: Copyright © 2015 by the Endocrine Society. Context: Hemoglobin A1c (HbA1c) ≥6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians. Objective: To examine the relationship between HbA1c and diabetes-specific moderate retinopathy in Asian ethnic groups. Design, Setting, and Participants: Four independent population-based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n = 13 170 adults aged ≥25 y: Chinese, 5834; Malays, 3596; and Indians, 3740). Main Outcome: Moderate retinopathy was assessed from digital retinal photographs and defined as a level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for detecting moderate retinopathy were compared across ethnic groups at different HbA1c cut-points. Results: HbA1c levels were higher in Indians and Malays compared to Chinese (P < .001). The prevalence of moderate retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥6.5%, the sensitivity for detecting moderate retinopathy was lower in Chinese subjects compared to Indians and Malays (75.8 vs 86.0 and 85.3%), but specificity (89.7 vs 71.9 and 76.3%) was higher; however, positive predictive value and negative predictive value were similar among Chinese, Indians, and Malays (10.5, 12.3,12.4%; and 99.6, 99.1, 99.2%, respectively). The AUCs were similar across all three ethnic groups (0.861, 0.851, and 0.853). Conclusions: Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some interethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.
Source Title: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
URI: https://scholarbank.nus.edu.sg/handle/10635/169460
ISSN: 0021-972X
1945-7197
DOI: 10.1210/jc.2014-2498
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