Diagnosing type 2 diabetes using Hemoglobin A1c: a systematic review and meta-analysis of the diagnostic cutpoint based
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ORIGINAL ARTICLE
Diagnosing type 2 diabetes using Hemoglobin A1c: a systematic review and meta‑analysis of the diagnostic cutpoint based on microvascular complications Alexandra E. Butler1 · Emma English2 · Eric S. Kilpatrick3 · Linda Östlundh4 · Hiam S. Chemaitelly5 · Laith J. Abu‑Raddad5 · K. George M. M. Alberti6 · Stephen L. Atkin7 · W. Garry John2,8 Received: 20 August 2020 / Accepted: 11 September 2020 © The Author(s) 2020
Abstract Aims Diabetic microvascular complications of retinopathy, nephropathy and neuropathy may occur at hemoglobin A1c levels (HbA1c) below the 6.5% (48 mmol/mol) diagnostic threshold. Our objective was to assess the validity of the HbA1c diagnostic cutpoint of 6.5% based upon published evidence of the prevalence of retinopathy, nephropathy and neuropathy as markers of diabetes. Methods Data Sources PubMed, Embase, Cochrane, Scopus and CINAHL from 1990-March 2019, grey literature sources. Study Selection All studies reported after 1990 (to ensure standardized HbA1c values) where HbA1c levels were presented in relation to prevalence of retinopathy, nephropathy or neuropathy in subjects not known to have diabetes. Data Extraction Studies were screened independently, data abstracted, and risk of bias appraised. Data Synthesis Data were synthesized using HbA1c categories of 40 years Mean age 56 years
> 40 years Mean age: Non-Hispanic White 56.7 ± 0.5; Non-Hispanic Black 53.5 ± 0.4; Hispanic American 51.9 ± 0.4)
38–87 years; median Sex differences in risk 62 years Norwegian factors for retinopathy in non-diabetic men and women: the Tromso Eye study
Title
5.66
Mid-point HbA1c [%] cutoff if only range given
5.7 5.8 5.9 6 6.1 6.3 6.5
5.5–6.4
5.7–6.4 6.1 6.1 6.1 6.5 6.5 6.5 6 6.5
5.62 ± 0.36 (females) 5.62
5.66 ± 0.36 (males)
HbA1c [%]
Two 45 degree non-mydriatic digital images were obtained from each eye. Retinopathy lesions graded according to a modified Airlie House classification system, as used in the ETDRS; retinopathy > 14, no retinopathy 19 years Mean age 44.3 Glycemic and hemo44.3 ± 0.4 years Korean globin A1c thresholds for detecting diabetic retinopathy: the fifth Korea national Health and Nutrition Examination (2011)
HbA1c [%]
56.7 Glycated hemoglobin and Mean age 56.7 ± 2.7 the risk of kidney disease USA: White and Black, and retinopathy in adults results not separated with and without diabetes
Japanese
52 Prevalence of retinopathy Mean age: retinopathy absent 51 ± 8; retinopaand its risk factors in a thy present 53 ± 7 years Japanese population
Title
6.1 6.5
6.5
6.1
Mid-point HbA1c [%] cutoff if only range given
Two retinal photographs per subject used for retinal grading. Retinopathy defined by the presence of microaneurysms, any retinal hemorrhage, soft and hard exudates One 45 degree non-mydriatic digital images obtained from a random eye. Retinopathy lesions graded according to a modified Airlie House classification system, as used in the ETDRS; retinopathy > 14, no retinopathy 40 years Mean age: White 57.1 ± 0.4 years, Black 54.4 ± 0.4 years
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