The simultaneous assessment of glycosylated hemoglobin, fasting plasma glucose and oral glucose tolerance test does not improve the detection of type 2 diabetes mellitus in Colombian adults

Jose Lopez-Lopez, Jennifer Garay, Edwin Wandurraga, Paul A Camacho, Fernando Higuera-Escalante, Daniel Cohen, Patricio Lopez-Jaramillo, Jose Lopez-Lopez, Jennifer Garay, Edwin Wandurraga, Paul A Camacho, Fernando Higuera-Escalante, Daniel Cohen, Patricio Lopez-Jaramillo

Abstract

Introduction: Guidelines recommend early detection of type 2 diabetes mellitus (DM2). The objective of the present study was to evaluate the capacity to identify DM2 in subjects that were screened for DM2 simultaneously with all three of the tests recommended-fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and a 2-hour post 75-g oral glucose tolerance test (OGTT).

Methods and results: The present analysis of an anonymous database of 1113 adults from a reference clinical laboratory in Bucaramanga, Colombia, was an observational, descriptive, cross-sectional secondary source study. 259 individuals met at least one of the criteria for DM2: FPG ≥ 126mg/dL (7.0mmol/L), HbA1c ≥ 6.5% (48mmol/mol) and OGTT ≥ 200mg/dL (11.1mmol/L). 30 subjects (2.7%) were diabetic according to FPG, 56 subjects (5.0%) by HbA1c and 250 subjects (22.5%) by OGTT. In total 259 subjects (23.3% [IC 95%: 20.7%- 25.8%] were diabetic either by FPG, OGTT or HbA1c.

Discussion: The largest number of patients were identified as diabetic with the OGTT. The combination of two or three tests did not increase the detection of new cases of DM2. Our findings suggest that routinely requesting FPG, OGTT and HbA1c at the same time may be inappropriate in at risk individuals, as this approach does not significantly improve the diagnostic capacity compared to using FPG+OGTT and substantially increases the financial burden on the health system, insurers or individual.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Diagnosis of DM2 (N =…
Fig 1. Diagnosis of DM2 (N = 259) by fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), oral glucose tolerance test (OGTT), and by combinations of these tests.

References

    1. World Health Organisation. Diabetes Fact Sheet No 312 [Internet]. WHO; 2016 Available:
    1. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014. August;2(8):634–47. doi:
    1. Tunceli K, Bradley CJ, Nerenz D, Williams LK, Pladevall M, Elston Lafata J. The impact of diabetes on employment and work productivity. Diabetes Care. 2005. November;28(11):2662–7.
    1. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003. January 1;289(1):76–9.
    1. Aschner P MV, Giron D, Garcia O, Fernandez D. Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años. Colombia Médica. 2016;2(47):109–31.
    1. American Diabetes A. Standars of medical care in diabetes. Diabetes Care 2017. January; 40(Supplement 1): S11–S24
    1. Dagenais GR, Gerstein HC, Zhang X, McQueen M, Lear S, Lopez-Jaramillo P, et al. Variations in diabetes prevalence in low-, middle-, and high-income countries: Results from the prospective urban and rural epidemiology study. Diabetes Care. 2016. May;39(5):780–7 doi:
    1. Lopez-Jaramillo P, Velandia- Carrillo C, Gomez-Arbelaez D, Aldana-Campos M. Is the present cut-point to define type 2 diabetes appropriate in Latin-Americans?. World J Diabetes 2014. December;5(6):747–55. doi:
    1. Karnchanasorn R, Huang J, Ou HY, Feng W, Chuang LM, Chiu KC, Samoa R. Comparison of the Current Diagnostic Criterion of HbA1c with Fasting and 2-Hour Plasma Glucose Concentration. J Diabetes Res. 2016;2016:6195494 doi:
    1. Taback AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012. June 16;379(9833):2279–9. doi:
    1. Barry E, Roberts S, Oke J, Vijayaraghavan S, Normasenll R, Greenhalgh T. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. BMJ. 2017. January 4;356:i6538 doi:
    1. Warren B, Pankow JS, Matsushita K, Punjabi NM, Daya NR, Grams M, et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2017. January;5(1):34–42 doi:
    1. International Expert Committee. International Expert Committee report on the role of the HbA1c assay in the diagnosis of diabetes. Diabetes Care 2009. July; 32(7): 1327–1334. doi:
    1. WHO. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus: abbreviated report of a WHO consultation [Internet] Geneve: World Health Organization; 2011. Available:
    1. Clinical Guidelines Task Force. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation [Internet] 2012: Available:
    1. Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013. October;34(39):3035–87 doi:
    1. Choi SH, Kim TH, Lim S, Park KS, Jang HC, Cho NH. Hemoglobin HbA1c as a diagnostic tool for diabetes screening and new-onset diabetes prediction: a 6-year community-based prospective study. Diabetes Care 2011. April;34(4):944–9. doi:
    1. Millard AV, Graham MA, Mier N, Moralez J, Perez-Patron M, Wickwire B, May ML, Ory MG. Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community. Front Public Health. 2017. June 12;5:135 doi:
    1. Ehehalt S, Wiegand S, Körner A, Schweizer R, Liesenkötter KP, Partsch CJ, Blumenstock G, Spielau U, Denzer C, Ranke MB, Neu A, Binder G, Wabitsch M, Kiess W, Reinehr T. Diabetes screening in overweight and obese children and adolescents: choosing the right test. Eur J Pediatr. 2017. January;176(1):89–97. doi:
    1. Man B, Turyk ME, Kominiarek MA, Xia Y, Gerber BS. Diabetes Screening in US Women With a History of Gestational Diabetes, National Health and Nutrition Examination Survey, 2007–2012. Prev Chronic Dis. 2016. September 8;13:E124 doi:
    1. Shibata K, Suzuki S, Sato J, Ohsawa I, Goto S, Iritani I, et al. Diagnostic accuracy of glycohemoglobin HbA1c (HbA1c) for postprandial hyperglycemia was equivalent to that of fasting blood glucose. J Clin Epidemiol. 2005. October;58(10):1052–7. doi:
    1. Bennett CM, Guo M, Dharmage SC. HbA(1c) as a screening tool for detection of Type 2 diabetes: a systematic review. Diabet Med. 2007. April;24(4):333–43. doi:
    1. Cavagnolli G, Comerlato J, Comerlato C, Renz PB, Gross JL, Camargo JL. HbA(1c) measurement for the diagnosis of diabetes: is it enough?. Diabet Med. 2011. January;28(1):31–5.
    1. Kumaravel B, Bachmann MO, Murray N, Dhatariya K, Fenech M, John WG, et al. Use of haemoglobin HbA1c to detect impaired fasting glucose or Type 2 diabetes in a United Kingdom community based population. Diabetes Res Clin Pract. 2012. May;96(2):211–6. doi:
    1. Lee H, Oh JY, Sung YA, Kim DJ, Kim SH, Kim SG, et al. Optimal hemoglobin HbA1c Cutoff Value for Diagnosing type 2 diabetes mellitus in Korean adults. Diabetes Diabetes Res Clin Pract. 2013. February;99(2):231–6. doi:
    1. Barengo NC, Acosta T, Arrieta A, Ricaurte C, Mayor D, Toumilehto JO. Screening for people with glucose metabolism disorders within the framework of the DEMOJUAN project (DEMOnstration area for primary prevention of type 2 diabetes, JUAN Mina and Barranquilla, Colombia. Diabetes Metab [Internet]. Res Rev 2013. Available:
    1. Gomez-Arbelaez D, Alvarado-Jurado L, Ayala-Castillo M, Forero-Naranjo L, Camacho PA, Lopez-Jaramillo P. Evaluation of the Finnish Diabetes Risk Score to predict type 2 diabetes mellitus in a Colombian population: A longitudinal observational study. World J Diabetes. 2015. December 10; 6(17): 1337–1344. doi:

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