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Detecting Type 2 diabetes and impaired glucose regulation using glycated hemoglobin in different populations

Samiul A Mostafa, Kamlesh Khunti, Balasubramanian Thiagarajan,Srinivasan, David Webb & Melanie J Davies

Glycated hemoglobin, HbA1c, has recently been proposed as a diagnostic tool for detecting diabetes and impaired glucose regulation (IGR; also termed prediabetes). Many studies have reported the impact of using HbA1c to detect either glucose-defined diabetes or IGR. The aim of this article is to review recent studies from countries around the globe to assess these issues. Using HbA1c, greater than or equal to 6.5% to detect glucosedefined diabetes has a variable sensitivity of 17.0–78.2%, although specificity was generally stronger, at greater than 85%. Furthermore, most studies report that using the criteria HbA1c greater than or equal to 6.5% will decrease the prevalence of diabetes. Considering the development of glucose-defined diabetes in people without diabetes, HbA1c begins to show predictive values above 5.5–5.6%, although higher progression rates were reported at 5.9–6.1%. Most studies report the use of HbA1c as a poor tool to detect prevalent glucosedefined IGR, with a large degree of discordance between the results of people detected by different diagnostic tools.