Prevalence Of Diabetes And Association Of Fasting And Postprandial Glucose With Hba1c, 6-Year Study In Reference Laboratory

  • Sanjay Gohil Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Preeti Singh Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Megha Kambli Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Reshma Haryan Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Raj Jatale Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Rakhi Bajpai Dixit Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
  • Kirti Chadha Department of Haematology, Global Reference Laboratory, Metropolis Healthcare Limited, Vidyavihar, Mumbai, Maharashtra, India
Keywords: Diabetes, HbA1C, Indian Population, HPLC

Abstract

Background Prevalence of diabetes is estimated in the Indian population using hemoglobin A1c (HbA1c) data collected over the period of 6 years, in the Metropolis Reference Laboratory Mumbai. HbA1c values with gender and age structure was correlated during fasting and postprandial glucose for the non-diabetic, pre-diabetic, and diabetic populations in terms of frequency and percentile. Method Retrospective analysis of HbA1c data obtained in a referral laboratory based in Mumbai over a span of 6 years from 2015 to 2020. A total of 2,94,264 cases were divided in six age groups i.e. 15-20Y, 21-30Y, 31-40, 41-50, 51-60, and >60Y. High-performance liquid chromatographic separation and quantification of HbA1c in blood with gender and age were done. HbA1c values were also correlated with glucose fasting and postprandial in the studied population. Results Prevalence of diabetes (HbA1C >6.5) was 57.60% in the studied population. The incidence and prevalence of HbA1c in the diabetic range were highest in the age group of >60 years. Males showed a higher prevalence of diabetes than females, while females are found to be more pre-diabetic. A significant (p>0.001) positive linear correlation was found between HbA1c with fasting and postprandial glucose, respectively. Conclusion The age group of >60Y showed a maximum diabetic prevalence. Gender disparity was recorded more in males than females having higher HbA1c. The sensitivity of HbA1c is comparable with fasting and postprandial glucose. However, HbA1c cannot replace plasma glucose estimation and could be used in conjunction with fasting and postprandial glucose for proper diagnosis and disease management.

References

Hamdan-Mansour AM, Nawafa’h DNA, Hanouneh SI, Omari HDA. Psychosocial correlates of life satisfaction among patients diagnosed with type-II diabetes mellitus. Int. J. Diabetes Dev. Ctries. 2016;36:65-69.

Vijayakumar G, Manghat S, Vijayakumar R, Simon L, Scaria LM, Vijayakumar A, Sreehari GK, Kutty VR, Rachana A, and Jaleel A. Incidence of type 2 diabetes mellitus and prediabetes in Kerala, India: results from a 10-year prospective cohort. BMC Public Health. 2019;19:1-10.

Sun Hong, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, Pavkov ME, Ramachandaran A, Wild SH, James S, Herman WH, Zhang P, Bommer C, Kuo S, Boyko EJ, Magliano DJ. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res. Clin. Pract. 2022;183:109119.

Cho N, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res. Clin. Pract. 2018;138:271-81.

Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019;62:3-16.

Lee KW, Ching SM, Devaraj NK, Chong SC, Lim SY, Loh HC, Abdul Hamid H. Diabetes in pregnancy and risk of antepartum depression: a systematic review and meta-analysis of cohort studies. Int. J. Environ. Health Res. 2020;17:3767.

Devaraj NK. Knowledge, attitude, and practice regarding obstructive sleep apnea among primary care physicians. Sleep. Breath. 2020;24:1581-1590.

Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark. Insights. 2016;11:BMI-S38440.

American Diabetes Association. Standards of medical care in diabetes - 2021 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association. 2021;39:14.

Prabha AGT. Comparison of the analytical techniques of hba1c estimation by immunoturbidimetric and HPLC methods in diabetic and pre-diabetics patients. Int. J. Clin. Biochem. Res. 2017;4:187-190.

Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE. Defining the relationship between plasma glucose and HbA1c: analysis of glucose profiles and HbA1c in the diabetes control and complications trial. Diabetes Care. 2002;25:275-278.

Nathan DM, Kuenen J, Borg R, Zheng H, Schoen-feld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31:1473-1478.

Rajput R, Saini O, Rajput M, Shankar V. Comparison of HbA1c and FPG as a screening tool for diagnosis of pre-diabetes and diabetes in Indian population. Int J Diabetes Dev Ctries. 2015;35:559-564.

Feng L, Nian S, Zhao Y, Bai X, Luo F, Luo X, Xu W, Ye D, Tong Z. Higher HbA1c and/or glucose levels alter the association patterns between glycated hemoglobin and fasting glucose levels. Diabetes Res. Clin. Pract. 2018;142:353-362.

Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J. Diabetes. 2009;1:9-17.

de Cássia Lima Fernandes R, Teló GH, Cureau FV, Barufaldi LA, Kuschnir MC, Schaan BD, Szklo M, Bloch KV. Prevalence of high HbA1c levels in Brazilian adolescents: The study of cardiovascular risk in adolescents. Diabetes Res. Clin. Pract. 2017;125:1-9.

Ziemer DC, Kolm P, Weintraub WS, Vaccarino V, Rhee MK, Twombly JG, Narayan KV, Koch DD, Phillips LS. Glucose-independent, black–white differences in hemoglobin A1c levels: a cross-sectional analysis of 2 studies. Ann. Intern Med. 2010 Jun 15;152(12):770-7.

Herman WH, Cohen RM. Racial and ethnic differences in the relationship between HbA1c and blood glucose: implications for the diagnosis of diabetes. J Clin Endocrinol Metab. 2012;97:1067-72.

Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011;34:S184-S190.

Ortiz-Martínez M, González-González M, Martagón AJ, Hlavinka V, Willson RC, Rito-Palomares M. Recent Developments in Biomarkers for Diagnosis and Screening of Type 2 Diabetes Mellitus. Curr. Diabetes Rep. 2022;1-21.

Pippitt K, Li M, Gurgle HE. Diabetes mellitus: screening and diagnosis. Am Fam Physician. 2016;93:103-109.

von Eckardstein A, Roth HJ, Jones G, Preston S, Szekeres T, Imdahl R, Conti M, Blanckaert N, Jose D, Thiery J, Feldmann L. Cobas 8000 modular analyzer series evaluated under routine-like conditions at 14 sites in Australia, Europe, and the United States. J. Lab. Autom. 2013;18:306-27.

Liu J, Ren ZH, Qiang H, Wu J, Shen M, Zhang L, Lyu J. Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention. BMC Public Health. 2020;20:1-2.

Zhang H, Ni J, Yu C, Wu Y, Li J, Liu J, Tu J, Ning X, He Q, Wang J. Sex-based differences in diabetes prevalence and risk factors: a population-based cross-sectional study among low-income adults in China. Front. Endocrinol. 2019:658.

Nordström A, Hadrévi J, Olsson T, Franks PW, Nordström P. Higher prevalence of type 2 diabetes in men than in women is associated with differences in visceral fat mass. J. Clin. Endocrinol. Metab. 2016;101:3740-3746.

Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, Adhikari P, Rao PV, Saboo B, Kumar A, Bhansali A. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endo. 2017;5:585-596.

Nagarathna R, Kaur N, Anand A, Sharma K, Dada R, Sridhar P, Sharma P, Singh AK, Patil S, Nagendra HR. Distribution of glycated haemoglobin and its determinants in Indian young adults. Diabetes Res. Clin. Pract. 2020;159:107982.

Haddadinezhad S, Ghazaleh N. Relation of fasting and postprandial and plasma glucose with hemoglobinA1c in diabetics. Int. J. Diabetes Dev. Ctries. 2010;30:8-10.

Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J. Clin. Endocrinol. Metabol. 2006;91:813-819.

Published
27-08-2023
Section
Original Article