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Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0003-1169-2172
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-9225-1306
Number of Authors: 7782023 (English)In: Nature Medicine, ISSN 1078-8956, E-ISSN 1546-170X, Vol. 29, p. 2885-2901Article in journal (Refereed) Published
Abstract [en]

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023. Vol. 29, p. 2885-2901
Keywords [en]
Diabetes, Diagnosis, Diagnostic markers, Epidemiology, Public health
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-216912DOI: 10.1038/s41591-023-02610-2ISI: 001103103800003PubMedID: 37946056Scopus ID: 2-s2.0-85176735771OAI: oai:DiVA.org:umu-216912DiVA, id: diva2:1813269
Available from: 2023-11-20 Created: 2023-11-20 Last updated: 2025-04-24Bibliographically approved

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Forsner, MariaSöderberg, Stefan

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Department of NursingDepartment of Public Health and Clinical Medicine
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