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Effects of Diabetes Definition on Global Surveillance of Diabetes Prevalence and Diagnosis: A Pooled Analysis of 96 Population-Based Studies With 331 288 Participants Publisher Pubmed



Danaei G1 ; Fahimi S1 ; Lu Y1 ; Zhou B2 ; Hajifathalian K1 ; Cesare MD2 ; Lo WC3 ; Reissantos B4 ; Cowan MJ5, 11 ; Shaw JE6 ; Bentham J2 ; Lin JK7 ; Bixby H2 ; Magliano D6 Show All Authors
Authors
  1. Danaei G1
  2. Fahimi S1
  3. Lu Y1
  4. Zhou B2
  5. Hajifathalian K1
  6. Cesare MD2
  7. Lo WC3
  8. Reissantos B4
  9. Cowan MJ5, 11
  10. Shaw JE6
  11. Bentham J2
  12. Lin JK7
  13. Bixby H2
  14. Magliano D6
  15. Bovet P8, 251
  16. Miranda JJ9
  17. Khang YH10
  18. Stevens GA5, 11
  19. Riley LM5, 11
  20. Ali MK12
  21. Ezzati M2
  22. Kadir KA13
  23. Aburmeileh NM14
  24. Acostacazares B15
  25. Aekplakorn W16
  26. Aguilarsalinas CA17
  27. Ahmadvand A18
  28. Nsour MA19
  29. Alkerwi A20
  30. Amouyel P21
  31. Andersen LB22, 40
  32. Anderssen SA23
  33. Andrade DS24
  34. Anjana RM25
  35. Aounallahskhiri H26
  36. Aris T27
  37. Arlappa N28
  38. Arveiler D29
  39. Assah FK30
  40. Avdicova M31
  41. Balakrishna N28
  42. Bandosz P32
  43. Barbagallo CM33
  44. Batieha AM35
  45. Baur LA36
  46. Romdhane HB37
  47. Bernabeortiz A9
  48. Bhargava SK38
  49. Bi Y39
  50. Bjerregaard P22, 40, 252
  51. Bjorkelund C41
  52. Blake M42
  53. Blokstra A43
  54. Bo S44
  55. Boehm BO45
  56. Boissonnet CP46
  57. Brajkovich I47
  58. Breckenkamp J48
  59. Brewster LM49
  60. Brian GR50
  61. Bruno G44
  62. Bugge A22, 40
  63. De Leon AC51
  64. Can G52
  65. Candido APC4
  66. Capuano V53
  67. Carvalho MJ54
  68. Casanueva FF55
  69. Caserta CA56
  70. Castetbon K57
  71. Chamukuttan S58
  72. Chaturvedi N59
  73. Chen CJ60
  74. Chen F61
  75. Chen S62
  76. Cheng CY63
  77. Chetrit A64
  78. Chiou ST65
  79. Cho Y66
  80. Chudek J67
  81. Cifkova R68
  82. Claessens F69
  83. Concin H70
  84. Cooper C71
  85. Cooper R59
  86. Costanzo S72
  87. Cottel D73
  88. Cowell C74
  89. Crujeiras AB75
  90. Darrigo G76
  91. Dallongeville J73
  92. Dankner R64
  93. Dauchet L77
  94. De Gaetano G72
  95. De Henauw S78
  96. Deepa M25
  97. Dehghan A79
  98. Dhana K79
  99. Di Castelnuovo AF72
  100. Djalalinia S18
  101. Doua K80
  102. Drygas W81
  103. Du Y82
  104. Egbagbe EE83
  105. Eggertsen R41
  106. Ati JE84
  107. Elosua R85
  108. Erasmus RT86
  109. Erem C87
  110. Ergor G88
  111. Eriksen L22, 40
  112. Escobedode La Pena J15
  113. Fall CH89
  114. Farzadfar F18
  115. Felixredondo FJ90
  116. Ferguson TS91
  117. Fernandezberges D92
  118. Ferrari M93
  119. Ferreccio C94
  120. Finn JD95
  121. Foger B70
  122. Foo LH96
  123. Fouad HM97
  124. Francis DK91
  125. Do Carmo Franco M98
  126. Franco OH79
  127. Frontera G99
  128. Furusawa T100
  129. Gaciong Z101
  130. Galbarczyk A102
  131. Garnett SP36
  132. Gaspoz JM103
  133. Gasull M104
  134. Gates L105
  135. Geleijnse JM106
  136. Ghasemain A18
  137. Giampaoli S107
  138. Gianfagna F108
  139. Giovannelli J77
  140. Gross MG109
  141. Gonzalez Rivas JP110
  142. Gorbea MB111
  143. Gottrand F112
  144. Grant JF113
  145. Grodzicki T102
  146. Grontved A22, 40
  147. Gruden G44
  148. Gu D114
  149. Guan OP115
  150. Guerrero R116
  151. Guessous I103
  152. Guimaraes AL117
  153. Gutierrez L118
  154. Hardy R59
  155. Kumar RH28
  156. He J119
  157. Heidemann C82
  158. Hihtaniemi IT2
  159. Ho SY120
  160. Ho SC121
  161. Hofman A79
  162. Russo Horimoto ARV122
  163. Hormiga CM123
  164. Horta BL4
  165. Houti L124
  166. Hussieni AS14
  167. Huybrechts I125
  168. Hwalla N126
  169. Iacoviello L72
  170. Iannone AG53
  171. Ibrahim MM127
  172. Ikeda N128
  173. Ikram AM79
  174. Irazola VE118
  175. Islam M129
  176. Iwasaki M130
  177. Jacobs JM131
  178. Jafar T63
  179. Jasienska G102
  180. Jiang CQ120
  181. Jonas JB132
  182. Joshi P133
  183. Kafatos A134
  184. Kalterleibovici O64
  185. Kasaeian A18
  186. Katz J135
  187. Kaur P136
  188. Kavousi M79
  189. Kelishadi R137
  190. Kengne AP138
  191. Kersting M139
  192. Khader YS35
  193. Kiechl S140
  194. Kim J141
  195. Kiyohara Y142
  196. Kolsteren P143
  197. Korrovits P144
  198. Koskinen S145
  199. Kratzer W146
  200. Kromhout D106
  201. Kula K147
  202. Kurjata P81
  203. Kyobutungi C148
  204. Lachat C78
  205. Laid Y149
  206. Lam TH120
  207. Landrove O150
  208. Lanska V151
  209. Lappas G152
  210. Laxmaiah A28
  211. Leclercq C153
  212. Lee J154
  213. Lee J154
  214. Lehtimaki T155
  215. Rampal L156
  216. Leonmunoz LM157
  217. Li Y1
  218. Lim WY154
  219. Fernanda Limacosta M158
  220. Lin HH3
  221. Lin X236
  222. Lissner L41
  223. Lorbeer R159
  224. Lozano JE160
  225. Lundqvist A145
  226. Lytsy P161
  227. Ma G162
  228. Machadocoelho GLL4
  229. Machi S163
  230. Maggi S76
  231. Makdisse M164
  232. Rao KM28
  233. Manios Y165
  234. Manzato E166
  235. Margozzini P94
  236. Marquesvidal P167
  237. Martorell R12
  238. Masoodi SR168
  239. Matsha TE169
  240. Mbanya JCN170
  241. Mcfarlane SR91
  242. Mcgarvey ST171
  243. Mclachlan S172
  244. Mcnulty BA173
  245. Medienebenchekor S124
  246. Meirhaeghe A174
  247. Menezes AMB4
  248. Merat S18
  249. Meshram II28
  250. Mi J61
  251. Miquel JF94
  252. Mohamed MK175
  253. Mohammad K18
  254. Mohan V25
  255. Yusoff MFM27
  256. Moller NC22, 40
  257. Molnar D176
  258. Mondo CK177
  259. Moreno LA178
  260. Morgan K179
  261. Moschonis G165
  262. Mossakowska M180
  263. Mostafa A175
  264. Mota J54
  265. Muiesan ML181
  266. Mullernurasyid M182
  267. Mursu J183
  268. Nagel G184
  269. Namesna J31
  270. Nang EEK154
  271. Nangia VB185
  272. Navarretemunoz EM186
  273. Ndiaye NC174
  274. Nervi F94
  275. Nguyen ND187
  276. Nietomartinez RE188
  277. Ning G39
  278. Ninomiya T142
  279. Noale M76
  280. Noto D33
  281. Ochoaaviles AM24
  282. Oh K66
  283. Onat A52
  284. Osmond C89
  285. Otero JA123
  286. Palmieri L107
  287. Pandajonas S32
  288. Panza F189
  289. Parsaeian M18
  290. Peixoto SV158
  291. Pereira AC122
  292. Peters A182
  293. Peykari N18
  294. Pilav A190
  295. Pitakaka F191
  296. Piwonska A81
  297. Piwonski J81
  298. Plansrubio P192
  299. Porta M193
  300. Portegies MLP79
  301. Poustchi H18
  302. Pradeepa R25
  303. Price JF172
  304. Punab M144
  305. Qasrawi RF194
  306. Qorbani M195
  307. Raitakari O196
  308. Rao SR136
  309. Ramachandran A58
  310. Ramos R197
  311. Rampal S198
  312. Rathmann W199
  313. Redon J200
  314. Reganit PFM201
  315. Rigo F202
  316. Robinson SM71
  317. Robitaille C203
  318. Rodriguez LA204
  319. Rodriguezartalejo F157
  320. Rodriguezperez MDC51
  321. Rojasmartinez R205
  322. Romaguera D206
  323. Rosengren A152
  324. Rubinstein A118
  325. Rui O207
  326. Ruizbetancourt BS15
  327. Rutkowski M32
  328. Sabanayagam C115
  329. Sachdev HS208
  330. Saidi O37
  331. Sakarya S209
  332. Salanave B57
  333. Salonen JT210
  334. Salvetti M181
  335. Sanchezabanto J211
  336. Dos Santos RN212
  337. Santos R54
  338. Sardinha LB213
  339. Scazufca M212
  340. Schargrodsky H214
  341. Scheidtnave C82
  342. Shibuya K215
  343. Shin Y115
  344. Shiri R216
  345. Siantar R115
  346. Sibai AM126
  347. Simon M58
  348. Simons J217
  349. Simons LA191
  350. Sjostrom M218
  351. Slowikowskahilczer J147
  352. Slusarczyk P180
  353. Smeeth L219
  354. Snijder MB49
  355. Solfrizzi V220
  356. Sonestedt E221
  357. Soumare A222
  358. Staessen JA223
  359. Steenejohannessen J23
  360. Stehle P224
  361. Stein AD12
  362. Stessman J131
  363. Stockl D182
  364. Stokwiszewski J225
  365. Strufaldi MW98
  366. Sun CA226
  367. Sundstrom J227
  368. Suriyawongpaisal P16
  369. Sy RG201
  370. Tai ES154
  371. Tarawneh M228
  372. Tarquimamani CB211
  373. Thijs L223
  374. Tolstrup JS22, 40
  375. Topbas M87
  376. Torrent M229
  377. Traissac P230
  378. Trinh OTH187
  379. Tullochreid MK91
  380. Tuomainen TP183
  381. Turley ML231
  382. Tzourio C222
  383. Ueda P1
  384. Ukoli FM239
  385. Ulmer H240
  386. Valdivia G94
  387. Van Valkengoed IGM241
  388. Vanderschueren D69
  389. Vanuzzo D242
  390. Vega T243
  391. Velasquezmelendez G244
  392. Veronesi G108
  393. Verschuren M43
  394. Vioque J245
  395. Virtanen J183
  396. Visvikissiest S174
  397. Viswanathan B251
  398. Vollenweider P167
  399. Voutilainen S183
  400. Wade AN246
  401. Wagner A247
  402. Walton J248
  403. Mohamud WNW249
  404. Wang MD203
  405. Wang YX250
  406. Wannamethee SG59
  407. Weerasekera D231
  408. Whincup PH232
  409. Widhalm K233
  410. Wiecek A67
  411. Wilks RJ91
  412. Willeit J140
  413. Wojtyniak B225
  414. Wong TY63
  415. Woo J121
  416. Woodward M36, 234
  417. Wu AG221
  418. Wu FC95
  419. Wu SL62
  420. Xu H235
  421. Yang X236
  422. Ye X237
  423. Yoshihara A130
  424. Youngercoleman NO91
  425. Zambon S166
  426. Zargar AH238
  427. Zdrojewski T32
  428. Zhao W236
  429. Zheng Y115
Show Affiliations
Authors Affiliations
  1. 1. Harvard T H Chan School of Public Health, United States
  2. 2. Imperial College London, United Kingdom
  3. 3. National Taiwan University, Taiwan
  4. 4. Universidade Federal de Pelotas, Brazil
  5. 5. World Health Organization, Switzerland
  6. 6. Baker IDI Heart, Australia
  7. 7. University of California San Francisco, United States
  8. 8. University of Lausanne, Switzerland
  9. 9. Universidad Peruana Cayetano Heredia, Peru
  10. 10. Seoul National University, South Korea
  11. 11. World Health Organization, Switzerland
  12. 12. Emory University, United States
  13. 13. Monash University Malaysia, Malaysia
  14. 14. Birzeit University, Palestine
  15. 15. Instituto Mexicano del Seguro Social, Mexico
  16. 16. Mahidol University, Thailand
  17. 17. Instituto Nacional de Ciencias Medicas y Nutricion, Mexico
  18. 18. Tehran University of Medical Sciences, Iran
  19. 19. Eastern Mediterranean Public Health Network, Jordan
  20. 20. Luxembourg Health Institute, Luxembourg
  21. 21. Lille University and Hospital, France
  22. 22. University of Southern Denmark, Denmark
  23. 23. Norwegian School of Sport Sciences, Norway
  24. 24. Universidad de Cuenca, Ecuador
  25. 25. Madras Diabetes Research Foundation, India
  26. 26. National Institute of Public Health, Tunisia
  27. 27. Ministry of Health Malaysia, Malaysia
  28. 28. Indian Council of Medical Research, India
  29. 29. Strasbourg University and Hospital, France
  30. 30. Health of Populations in Transition Research Group, Cameroon
  31. 31. Regional Authority of Public Health, Banska Bystrica, Slovakia
  32. 32. Medical University of Gdansk, Poland
  33. 33. University of Palermo, Italy
  34. 34. Pan American Health Organization, United States
  35. 35. Jordan University of Science and Technology, Jordan
  36. 36. University of Sydney, Australia
  37. 37. University Tunis El Manar, Tunisia
  38. 38. Sunder Lal Jain Hospital, India
  39. 39. Shanghai Jiao-Tong University School of Medicine, China
  40. 40. University of Southern Denmark, Denmark
  41. 41. University of Gothenburg, Sweden
  42. 42. NatCen Social Research, United Kingdom
  43. 43. National Institute for Public Health and the Environment, Netherlands
  44. 44. University of Turin, Italy
  45. 45. Nanyang Technological University, Singapore
  46. 46. Centro de Educacion Medica e Investigaciones Clinicas, Argentina
  47. 47. Universidad Central de Venezuela, Venezuela
  48. 48. Bielefeld University, Germany
  49. 49. University of Amsterdam, Netherlands
  50. 50. The Fred Hollows Foundation New Zealand, New Zealand
  51. 51. Canarian Health Service, Spain
  52. 52. Istanbul University, Turkey
  53. 53. Reparto di Cardiologia ed UTIC di Mercato S., Italy
  54. 54. University of Porto, Portugal
  55. 55. Santiago de Compostela University, Spain
  56. 56. Associazione Calabrese di Epatologia, Italy
  57. 57. French Institute for Health Surveillance, France
  58. 58. India Diabetes Research Foundation, India
  59. 59. University College London, United Kingdom
  60. 60. Academia Sinica, Taiwan
  61. 61. Capital Institute of Pediatrics, China
  62. 62. Kailuan General Hospital, China
  63. 63. Duke-NUS Graduate Medical School, Singapore
  64. 64. The Gertner Institute for Epidemiology, Health Policy Research, Israel
  65. 65. Ministry of Health and Welfare, Taiwan
  66. 66. Korea Centers for Disease Control and Prevention, South Korea
  67. 67. Medical University of Silesia, Poland
  68. 68. Charles University in Prague, Czech Republic
  69. 69. Katholieke Universiteit Leuven, Belgium
  70. 70. Agency for Preventive, Austria
  71. 71. University of Southampton, United Kingdom
  72. 72. IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy
  73. 73. Institut Pasteur de Lille, France
  74. 74. Westmead University of Sydney, Australia
  75. 75. CIBERobn, Spain
  76. 76. National Research Council, Italy
  77. 77. Lille University Hospital, France
  78. 78. Ghent University, Belgium
  79. 79. University Medical Center Rotterdam, Netherlands
  80. 80. Ministere de la Sante et de la Lutte contre le Sida, Cote d'Ivoire
  81. 81. The Cardinal Wyszynski Institute of Cardiology, Poland
  82. 82. Robert Koch Institute, Germany
  83. 83. University of Benin College of Medical Sciences, Nigeria
  84. 84. and Food Technology, Tunisia
  85. 85. Institut Hospital del Mar d'Investigacions Mediques, Spain
  86. 86. University of Stellenbosch, South Africa
  87. 87. Karadeniz Technical University, Turkey
  88. 88. Dokuz Eylul University, Turkey
  89. 89. MRC Lifecourse Epidemiology Unit, United Kingdom
  90. 90. Centro de Salud Villanueva Norte, Spain
  91. 91. The University of the West Indies, Jamaica
  92. 92. Hospital Don Benito-Villanueva de la Serena, Spain
  93. 93. National Research Institute on Food and Nutrition, Italy
  94. 94. Pontificia Universidad Catolica de Chile, Chile
  95. 95. University of Manchester, United Kingdom
  96. 96. Universiti Sains Malaysia, Malaysia
  97. 97. World Health Organization Regional Office for the Eastern Mediterranean, Egypt
  98. 98. Federal University of Sao Paulo, Brazil
  99. 99. Hospital Universitario Son Espases, Spain
  100. 100. Kyoto University, Japan
  101. 101. Medical University of Warsaw, Poland
  102. 102. Jagiellonian University Medical College, Poland
  103. 103. Geneva University Hospitals, Switzerland
  104. 104. CIBER en Epidemiologia y Salud Publica, Spain
  105. 105. Australian Bureau of Statistics, Australia
  106. 106. Wageningen University, Netherlands
  107. 107. Istituto Superiore di Sanita, Italy
  108. 108. University of Insubria, Italy
  109. 109. Universidad Politecnica de Madrid, Spain
  110. 110. The Andes Clinic of Cardio-Metabolic Studies, Venezuela
  111. 111. National Institute of Hygiene, Epidemiology and Microbiology, Cuba
  112. 112. Universite de Lille 2, France
  113. 113. The University of Adelaide, Australia
  114. 114. National Center of Cardiovascular Diseases, China
  115. 115. Singapore Eye Research Institute, Singapore
  116. 116. Universidad Icesi, Colombia
  117. 117. State University of Montes Claros, Brazil
  118. 118. Institute for Clinical Effectiveness and Health Policy, Argentina
  119. 119. Tulane University, United States
  120. 120. University of Hong Kong, Hong Kong
  121. 121. The Chinese University of Hong Kong, Hong Kong
  122. 122. Heart Institute, Brazil
  123. 123. Fundacion Oftalmologica de Santander, Colombia
  124. 124. University of Oran 1, Algeria
  125. 125. International Agency for Research on Cancer, France
  126. 126. American University of Beirut, Lebanon
  127. 127. Cairo University, Egypt
  128. 128. National Institute of Health and Nutrition, Japan
  129. 129. Aga Khan University, Pakistan
  130. 130. Niigata University, Japan
  131. 131. Hadassah University Medical Center, Israel
  132. 132. Ruprecht-Karls-University of Heidelberg, Germany
  133. 133. World Health Organization Country Office, India
  134. 134. University of Crete, Greece
  135. 135. Johns Hopkins Bloomberg School of Public Health, United States
  136. 136. National Institute of Epidemiology, India
  137. 137. Isfahan University of Medical Sciences, Iran
  138. 138. South African Medical Research Council, South Africa
  139. 139. Research Institute of Child Nutrition, Germany
  140. 140. Medical University Innsbruck, Austria
  141. 141. National Cancer Center, South Korea
  142. 142. Kyushu University, Japan
  143. 143. Institute of Tropical Medicine, Belgium
  144. 144. Tartu University Clinics, Estonia
  145. 145. National Institute for Health and Welfare, Finland
  146. 146. University Hospital Ulm, Germany
  147. 147. Medical University of Lodz, Poland
  148. 148. African Population and Health Research Center, Kenya
  149. 149. National Institute of Public Health, Algeria
  150. 150. Ministerio de Salud Publica, Cuba
  151. 151. Institute for Clinical and Experimental Medicine Prague, Czech Republic
  152. 152. Sahlgrenska Academy, Sweden
  153. 153. Food and Agriculture Organization, Italy
  154. 154. National University of Singapore, Singapore
  155. 155. Tampere University Hospital, Finland
  156. 156. Universiti Putra Malaysia, Malaysia
  157. 157. Universidad Autonoma de Madrid, Spain
  158. 158. Oswaldo Cruz Foundation Rene Rachou Research Institute, Brazil
  159. 159. University Medicine Greifswald, Germany
  160. 160. Consejeria de Sanidad Junta de Castilla y Leon, Spain
  161. 161. University of Uppsala, Sweden
  162. 162. Peking University, China
  163. 163. The Jikei University School of Medicine, Japan
  164. 164. Hospital Israelita Albert Einstein, Brazil
  165. 165. Harokopio University of Athens, Greece
  166. 166. University of Padova, Italy
  167. 167. Lausanne University Hospital, Switzerland
  168. 168. Sher-i-Kashmir Institute of Medical Sciences, India
  169. 169. Cape Peninsula University of Technology, South Africa
  170. 170. University of Yaounde 1, Cameroon
  171. 171. Brown University, United States
  172. 172. University of Edinburgh, United Kingdom
  173. 173. University College Dublin, Ireland
  174. 174. INSERM, France
  175. 175. Ain Shams University, Egypt
  176. 176. University of Pecs, Hungary
  177. 177. Mulago Hospital, Uganda
  178. 178. Universidad de Zaragoza, Spain
  179. 179. PU-RCSI School of Medicine, Malaysia
  180. 180. International Institute of Molecular and Cell Biology, Poland
  181. 181. University of Brescia, Italy
  182. 182. Helmholtz Zentrum Munchen, Germany
  183. 183. University of Eastern Finland, Finland
  184. 184. University of Ulm, Germany
  185. 185. Suraj Eye Institute, India
  186. 186. CIBER de Epidemiologia y Salud Publica, Spain
  187. 187. University of Pharmacy, Medicine of Ho Chi Minh City, Viet Nam
  188. 188. Universidad Centro-Occidental Lisandro Alvarado, Venezuela
  189. 189. Unversity of Bari, Italy
  190. 190. Federal Ministry of Health, Bosnia and Herzegovina
  191. 191. University of New South Wales, Australia
  192. 192. Public Health Agency of Catalonia, Spain
  193. 193. Hospital del Mar Medical Research Institute-IMIM, Spain
  194. 194. Al-Quds University, Palestine
  195. 195. Alborz University of Medical Sciences, Iran
  196. 196. University of Turku, Finland
  197. 197. Institut Universitari d'Investigacio en Atencio Primaria Jordi Gol, Spain
  198. 198. University of Malaya, Malaysia
  199. 199. German Diabetes Center, Germany
  200. 200. University of Valencia, Spain
  201. 201. University of the Philippines, Philippines
  202. 202. Health Center San Agustin, Spain
  203. 203. Public Health Agency of Canada, Canada
  204. 204. Universidad Industrial de Santander, Colombia
  205. 205. Instituto Nacional de Salud Publica, Mexico
  206. 206. Centre for Research in Environmental Epidemiology, Spain
  207. 207. University of Madeira, Portugal
  208. 208. Sitaram Bhartia Institute of Science Research, India
  209. 209. Marmara University, Turkey
  210. 210. University of Helsinki, Finland
  211. 211. National Institute of Health, Peru
  212. 212. University of Sao Paulo, Brazil
  213. 213. Universidade de Lisboa, Portugal
  214. 214. Hospital Italiano de Buenos Aires, Argentina
  215. 215. The University of Tokyo, Japan
  216. 216. Finnish Institute of Occupational Health, Finland
  217. 217. St Vincent's Hospital, Australia
  218. 218. Karolinska Institute, Sweden
  219. 219. London School of Hygiene and Tropical Medicine, United Kingdom
  220. 220. University of Bari, Italy
  221. 221. Lund University, Sweden
  222. 222. University of Bordeaux, France
  223. 223. University of Leuven, Belgium
  224. 224. Bonn University, Germany
  225. 225. National Institute of Hygiene, Poland
  226. 226. Fu Jen Catholic University, Taiwan
  227. 227. Uppsala University, Sweden
  228. 228. Ministry of Health, Jordan
  229. 229. Area de Salut de Menorca, Spain
  230. 230. Institut de Recherche pour le Developpement, France
  231. 231. Ministry of Health, New Zealand
  232. 232. St George's, University of London, United Kingdom
  233. 233. Medical University of Vienna, Austria
  234. 234. University of Oxford, United Kingdom
  235. 235. Institute of Food, Nutrition Development of Ministry of Agriculture, China
  236. 236. Chinese Center for Disease Control and Prevention, China
  237. 237. University of Chinese Academy of Sciences, China
  238. 238. Center for Diabetes and Endocrine Care, India
  239. 239. Meharry Medical College, United States
  240. 240. Medical University of Innsbruck, Austria
  241. 241. Academic Medical Center of University of Amsterdam, Netherlands
  242. 242. Centro di Prevenzione Cardiovascolare, Italy
  243. 243. Consejeria de Sanidad, Junta de Castilla y Leon, Spain
  244. 244. Universidade Federal de Minas Gerais, Brazil
  245. 245. Universidad Miguel Hernandez, Spain
  246. 246. University of the Witwatersrand, South Africa
  247. 247. University of Strasbourg, France
  248. 248. University College Cork, Ireland
  249. 249. Institute for Medical Research, Malaysia
  250. 250. Beijing Tongren Hospital, China
  251. 251. Ministry of Health, Seychelles
  252. 252. University of Greenland, Greenland

Source: The Lancet Diabetes and Endocrinology Published:2015


Abstract

Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. © 2015 NCD Risk Factor Collaboration.
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