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Poor accuracy of HbA1c for the diagnosis of prediabetes in overweight and obese Bangladeshi adults

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background/Purpose

The aim of the study was to assess the effect of obesity on the diagnostic accuracy of HbA1c.

Methods

This retrospective cross sectional study was conducted in 108 overweight/obese and 40 normal weight Bangladeshi adults. Those satisfying the exclusion and inclusion criteria were included. Diabetes and pre-diabetes were diagnosed by oral glucose tolerance test (OGTT) and HbA1c using the 2006 World Health Organization (WHO) diagnostic criteria. HbA1c was estimated by capillary electrophoresis method.

Results

108 overweight and obese (mean body mass index (BMI) 36.33 ± 8.86 kg/m2, mean age 29.12 ± 9.28 years) and 40 normal weight (mean BMI 20.35 ± 1.68 kg/m2, mean age 28.13 ± 6.22 years) adults were included in the study. Significantly greater number of patients were diagnosed with prediabetes using HbA1c criteria than OGTT criteria (39.68% vs 19.05%, p = 0.005) in overweight and obese group. The concordance between OGTT and HbA1c for the diagnosis of prediabetes was low in overweight and obese adults [Ƙ with 95%CI = 0.031(-0.194 to 0.256), n = 52]. The specificity and discrimination of HbA1c for the diagnosis of prediabetes were low in overweight and obese compared to normal weight group (52.3% vs 93.9%; 0.64 vs 0.89, p = 0.056, 95% CI = -0.01 to 0.51, respectively). The specificity of HbA1c for the diagnosis of prediabetes in adults with BMI ≥ 23 kg/m2 increased to 90% at a cut-off of 6.15%.

Conclusion

HbA1c was not accurate in the diagnosis of prediabetes in adults with BMI ≥ 23 kg/m2. A higher cut-off value for HbA1c should be used for the diagnosis of prediabetes, but not diabetes.

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Data Availability

Data is available on request from the corresponding author.

References

  1. Textbook of Diabetes, 4th edition. Edited by R. Holt, C. Cockram, A. Flyvbjerg and B. Goldstein. Blackwell Publishing. 2010

  2. Jain SK, Palmer M. The effect of oxygen radicals metabolites and vitamin E on glycosylation of proteins. Free RadicBiol Med. 1997;22:593–6.

    Article  CAS  Google Scholar 

  3. Sathiyapriya V, Selvaraj N, Nandeesha H, Bobby Z, Agrawal A, Sridhar MG, Pavithran P, RattinaDasse N. Increased glycation of hemoglobin and plasma proteins in normotensive, non-diabetic obese Indian subjects: putative role of lipid peroxides. ClinChem Lab Med. 2007;45(8):996–9.

    CAS  Google Scholar 

  4. Fonseca-Alaniz MH, Takada J, Alonso-Vale MI, Lima FB. Adipose tissue as an endocrineorgan: From theory to practice. J Pediatr. 2007;83(5):S192–203.

    Article  Google Scholar 

  5. Duvnjak M, Lerotic I, Barsic N, Tomasic V, Jukic L, Velagic V. Pathogenesis and management issues for non-alcoholic fatty liver disease. World J Gastroenterol. 2007;13:4539–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Khan N, Naz L, Yasmeen G. Obesity: An independent risk factor systemic oxidative stress. Park J Pharm Sci. 2006;19:62–9.

    CAS  Google Scholar 

  7. Monteiro R, Azevedo I. Chronic inflammation in obesity and the metabolic syndrome. Mediators Inflamm. 2010;2010:289645.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Buderer NMF. Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996;3(9):895–900.

    Article  CAS  PubMed  Google Scholar 

  9. Serdar MA, Serteser M, Ucal Y, Karpuzoglu HF, Aksungar FB, Coskun A, Kilercik M, Ünsal İ, Özpınar A. An Assessment of HbA1c in Diabetes Mellitus and Pre-diabetes Diagnosis: a Multi-centered Data Mining Study. Appl Biochem Biotechnol. 2020;190(1):44–56. https://doi.org/10.1007/s12010-019-03080-4.

    Article  CAS  PubMed  Google Scholar 

  10. Hossain MB, Khan MN, Oldroyd JC, Rana J, Magliago DJ, Chowdhury EK, et al. Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance. PLOS Glob Public Health. 2022;2(6):e0000461. https://doi.org/10.1371/journal.pgph.0000461.

    Article  PubMed  PubMed Central  Google Scholar 

  11. WHO Expert Consultation. Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157.

    Article  Google Scholar 

  12. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva, Switzerland: WHO Document Production Services 2006;1–46.

  13. Li J, Ma H, Na L, Jiang S, Lv L, Li G, Zhang W, Na G, Li Y, Sun C. Increased hemoglobin A1c threshold for prediabetes remarkably improving the agreement between A1c and oral glucose tolerance test criteria in obese population. J Clin Endocrinol Metab. 2015;100(5):1997–2005.

    Article  CAS  PubMed  Google Scholar 

  14. Chatzianagnostou K, Vigna L, Di Piazza S, Tirelli AS, Napolitano F, Tomaino L, Bamonti F, Traghella I, Vassalle C. Low concordance between HbA1c and OGTT to diagnose prediabetes and diabetes in overweight or obesity. Clin Endocrinol (Oxf). 2019;91(3):411–6.

    Article  CAS  PubMed  Google Scholar 

  15. Block G, Dietrich M, Norkus EP, Morrow JD, Hudes M, Caan B, Packer L. Factorsassociated with oxidative stress in human populations. Am J Epidemiol. 2002;156:274–85.

    Article  PubMed  Google Scholar 

  16. Esposito K, Ciotola M, Giugliano D. Oxidative stress in the Metabolic Syndrome. J Endocrinol Invest. 2006;29:791–5.

    Article  CAS  PubMed  Google Scholar 

  17. Pihl E, Zilmer K, Kullisaar T, Kairane C, Magi A, Zilmer M. Atherogenic inflammatory and oxidative stress markers in relation to overweight values in male former athletes. Int J Obesity. 2006;30:141–6.

    Article  CAS  Google Scholar 

  18. Chrysohoou C, Panagiotakos DB, Pitsavos C, Skoumas I, Papademetriou L, Economou M, Stefanadis C. The implication of obesity on total antioxidant capacity apparently healthy men and women: The ATTICA study. Nutr Metab Cardiovasc Dis. 2007;17:590–7.

    Article  PubMed  Google Scholar 

  19. Patel C, Ghanim H, Ravishankar S, Sia CL, Viswanathan P, Mohantym P, Dandona P. Prolonged reactive oxygen species generation and Nuclear Factor- kB activation after a high-fat, high-carbohydrate meal in the obese. J Clin Endocrinol Metab. 2007;92:4476–9.

    Article  CAS  PubMed  Google Scholar 

  20. Lapolla A, Traldi P, Fedele D. Importance of measuring products of non-enzymatic glycation of proteins. ClinBiochem. 2005;38:103–15.

    CAS  Google Scholar 

  21. Thewjitcharoen Y, Jones Elizabeth A, Butadej S, et al. Performance of HbA1c versus oral glucose tolerance test (OGTT) as a screening tool to diagnose dysglycemic status in high-risk Thai patients. BMC Endocr Disord 2019;19(23). https://doi.org/10.1186/s12902-019-0339-6

  22. The International Expert Committee. International expert committee report on the role of the a1c assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–34.

    Article  PubMed Central  Google Scholar 

  23. Monnier L, Colette C. Postprandial and basal hyperglycaemia in type 2 diabetes: contributions to overall glucose exposure and diabetic complications. Diabetes Metab. 2015;41(6):6S9-15.

    Article  CAS  PubMed  Google Scholar 

  24. Dessi M, Pieri M, Pignalosa S, Martino FG, Zenobi R. Performances of capillary electrophoresis and HPLC methods in HbA1c determination: diagnostic accuracy in HbS and HbD-Iran variants' presence. J Clin Lab Anal. 2015;29(1):57–60.

    Article  CAS  PubMed  Google Scholar 

  25. http:www.eslbioscience.com/hba1c.html (Accessed April 30, 2023)

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Acknowledgements

We would like to acknowledge the Obesity team, Department of Endocrinology, BSMMU, Dhaka. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors do not have any conflicts of interest.

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Authors and Affiliations

  1. Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Room 1620, 16Th Floor, Block D, Shahbag, Dhaka, 1000, Bangladesh

    Tahniyah Haq

  2. Department of Endocrinology, BSMMU, Room 1618, 16Th Floor, Block D, Shahbag, Dhaka, 1000, Bangladesh

    Md. Fariduddin

  3. Department of Endocrinology, BSMMU, Room 1524, 16Th Floor, Block D, Shahbag, Dhaka, 1000, Bangladesh

    Md Abul Hasanat

  4. Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh

    Nishat Nayla Aurpa

  5. Department of Endocrinology, BSMMU, 16Th Floor, Block D, Shahbag, Dhaka, 1000, Bangladesh

    Md. Sohel Rana Bhuiyan & Afia Zainab Tanni

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  1. Tahniyah Haq
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Correspondence to Tahniyah Haq.

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Ethical clearance

Consent for participation was obtained and the study was approved by the Institutional Review Board (IRB) of Bangabandhu Sheikh Mujib Medical University (BSMMU) [registration number 651]. Data were obtained from hospital records.

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Haq, T., Fariduddin, M., Hasanat, M.A. et al. Poor accuracy of HbA1c for the diagnosis of prediabetes in overweight and obese Bangladeshi adults. Int J Diabetes Dev Ctries (2023). https://doi.org/10.1007/s13410-023-01302-4

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