Combining glycosylated hemoglobin A(1c) and fasting plasma glucose for diagnosis of type 2 diabetes in Chinese adults

BACKGROUND: Glycosylated hemoglobin A(1c) (HbA(1c)) has been applied to identify type 2 diabetes (T2DM) in the U.S. and European countries. It has not been used in China mainly due to lack of a standardized approach to measure HbA(1c), short of knowledge about racial-specific standard and deficiency of an optimal cut-off point. METHODS: To evaluate combination of HbA(1c) and fasting plasma glucose (FPG) in diagnosing T2DM in Chinese adults, a multistage sampling cross-sectional study was conducted in Shanghai, China, in 2009. The FPG measurement, HbA(1c) assay, and oral glucose tolerance test (OGTT) were performed in 6,661 Chinese adults (3057 men, 3604 women) who had no prior history of diabetes to identify the unrecognized T2DM. RESULTS: A total of 454 participants were identified as T2DM based on the 1999 World Health Organization (WHO) diagnostic criteria. Of these patients, 239 were detected using an FPG ≥ 7.0 mmol/l and 141 were further identified using an HbA(1c) ≥ 43 mmol/mol (6.1%), achieving a sensitivity of 83.7% and a specificity of 89.3% for combining use of FPG and HbA(1c). In subjects at high risk of diabetes, the combining use of FPG and HbA(1c) produced a higher sensitivity and an improved positive predictive value (PPV), and had a satisfactory specificity and negative predictive value (NPV). CONCLUSIONS: The combining use of FPG and HbA(1c) is a potential screening and diagnosis approach for T2DM in Chinese adults, especially among those at high risk of the disease.