The Association of Retinopathy and Plasma Glucose and HbA1c: A Validation of Diabetes Diagnostic Criteria in a Chinese Population

Rui Zhang, Yufeng Li, Simin Zhang, Xiaoling Cai, Xianghai Zhou, Linong Ji, Rui Zhang, Yufeng Li, Simin Zhang, Xiaoling Cai, Xianghai Zhou, Linong Ji

Abstract

Aims. This study aimed to evaluate the associations of diabetic retinopathy (DR) with fasting plasma glucose (FPG), 2-hour postload plasma glucose (2hPG), and glycated hemoglobin A1c (HbA1c) in a Chinese population. Materials and Methods. A total of 3124 participants, identified from a population-based survey in Pinggu district, were examined by retinal photography (45°). DR was classified according to the Early Treatment Diabetic Retinopathy Study scale. FPG, 2hPG, and HbA1c were tested and categorized by deciles, with the prevalence of DR calculated in each decile. Results. The prevalence of DR increased sharply in the 10th deciles, when FPG exceeded 7.03 mmol/L and HbA1c exceeded 6.4%. Analysis of the receiver operating characteristic curves showed that the optimal cutoffs for detecting DR were 6.52 mmol/L and 5.9% for FPG and HbA1c, respectively. The World Health Organization (WHO) criteria for diagnosing diabetes showed high specificity (90.5-99.5%) and low sensitivity (35.3-65.0%). Further, 6 individuals with retinopathy had normal plasma glucose; however, their characteristics did not differ from those without retinopathy. Conclusions. Thresholds of FPG and HbA1c for detecting DR were observed, and the WHO criteria of diagnosing diabetes were shown to have high specificity and low sensitivity in this population.

Figures

Figure 1
Figure 1
Distribution of fasting plasma glucose (FPG) and the corresponding prevalence of diabetic retinopathy (DR) in the study population.
Figure 2
Figure 2
Distribution of glycated hemoglobin A1c (HbA1c) and the corresponding prevalence of diabetic retinopathy (DR) in the study population.
Figure 3
Figure 3
Prevalence of diabetic retinopathy (DR) according to the deciles of distribution of fasting plasma glucose (FPG) and glycated hemoglobin A1c (HbA1c) in the total 3124 subjects. The x-axis indicates the minimum value of each decile group.
Figure 4
Figure 4
Prevalence of diabetic retinopathy (DR) according to the deciles of distribution of fasting plasma glucose (FPG), 2-hour postload plasma glucose (2hPG), and glycated hemoglobin A1c (HbA1c) in 2959 subjects after excluding those with known diabetes. The x-axis indicates the minimum value of each decile group.
Figure 5
Figure 5
Receiver operating characteristic curves of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) for detecting diabetic retinopathy in the total 3124 subjects.
Figure 6
Figure 6
Receiver operating characteristic curves of glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour postload plasma glucose (2hPG) for detecting diabetic retinopathy in 2959 subjects after excluding those with known diabetes.

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Source: PubMed

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