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Haemoglobin A1c as a screening tool for type 2 diabetes and prediabetes in populations of Swedish and Middle-East ancestry

Journal article
Authors Margareta Hellgren
K. H. Steiner
L. Bennet
Published in Primary Care Diabetes
Volume 11
Issue 4
Pages 337-343
ISSN 1751-9918
Publication year 2017
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 337-343
Language en
Keywords Diabetes mellitus, Prediabetes, HbA1c, Diagnose, Screening, Ethnicity (no 8), impaired glucose-tolerance, glycated hemoglobin, insulin-resistance, fasting glucose, native swedes, life-style, mellitus, hba1c, prevention, immigrants, Endocrinology & Metabolism, General & Internal Medicine
Subject categories Clinical Medicine


Aims: To explore and compare sensitivity and specificity for HbA1c >= 48 mmol/mol as a predictor for type 2 diabetes mellitus (T2DM) in two populations with different ethnicity and to examine the predictive value of two levels of HbA1c (>= 42 mmol/mol, >= 39 mmol/mol) for prediabetes in these populations. Methods: Four cohorts were examined with an oral glucose tolerance test. (1) The MEDIM Study (n = 1991 individuals of Swedish and Iraqi ancestry); (2) The Skaraborg Project (n=1327 individuals of Swedish ancestry); (3) The 4-D study (n=424 individuals of Swedish, Iraqi and Turkish ancestry); (4) The Flemingsberg study (n = 212 participants of Turkish ancestry). Results: HbA1c >= 48 mmol/mol had a sensitivity for T2DM of 31% and 25% respectively in individuals of Middle-East and Swedish ancestry. The positive and negative predictive value was high in both populations (70.3, 96.4 and 96.2, 97.6 respectively). Using HbA1c >= 42 mmol/mol and >= 39 mmol/mol as a predictor for prediabetes gave a sensitivity of 17% and 36% in individuals of Middle-East and 15% and 34% in individuals of Swedish ancestry. Conclusions: Even if HbA1c >= 48 mmol/mol is a valuable diagnostic tool, it is a blunt and insensitive tool for screening and would exclude most people with T2DM, independent of ancestry and age. HbA1c is an inefficient way to detect individuals with prediabetes. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

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