Discordance between Fasting Plasma Glucose (FPG) and HbA1c in Diagnosing Diabetes and Pre-diabetes in The Malaysian Cohort

Nor Azian Abdul Murad; Noraidatulakma Abdullah; Mohd Arman Kamaruddin; Nazihah Abd Jalal; Norliza Ismail; Nurul Ain Mhd Yusof; Norlaila Mustafa; Rahman Jamal

doi:10.15605/jafes.036.02.02

Authors

Nor Azian Abdul Murad UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
Noraidatulakma Abdullah UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0002-7186-2455
Mohd Arman Kamaruddin UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0002-6157-4003
Nazihah Abd Jalal UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0001-9649-0048
Norliza Ismail UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0002-4707-7748
Nurul Ain Mhd Yusof UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
Norlaila Mustafa Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0002-0196-7091
Rahman Jamal UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia https://orcid.org/0000-0002-8354-8957

DOI:

https://doi.org/10.15605/jafes.036.02.02

Keywords:

type 2 diabetes mellitus, fasting plasma glucose, HbA1c, The Malaysian Cohort, diagnosis, population differences

Abstract

Objective. In this present study, we aim to evaluate the accuracy of the HbA1c relative to fasting plasma glucose (FPG) in the diagnosis of diabetes and pre-diabetes among The Malaysian Cohort (TMC) participants.

Methodology. FPG and HbA1c were taken from 40,667 eligible TMC participants that have no previous history of diabetes, aged between 35-70 years and were recruited from 2006 – 2012. Participants were classified as normal, diabetes and pre-diabetes based on the 2006 World Health Organization (WHO) criteria. Statistical analyses were performed using ANOVA and Chi-square test, while Pearson correlation and Cohen’s kappa were used to examine the concordance rate between FPG and HbA1c.
Results. The study samples consisted of 16,224 men and 24,443 women. The prevalence of diabetes among the
participants was 5.7% and 7.5% according to the FPG and HbA1c level, respectively. Based on FPG, 10.6% of the
participants had pre-diabetes but this increased to 14.2% based on HbA1c (r=0.86; P<0.001). HbA1c had a sensitivity of 58.20 (95% CI: 56.43, 59.96) and a specificity of 98.59 (95% CI: 98.46, 98.70).

Conclusion. A higher prevalence of pre-diabetes and diabetes was observed when using HbA1c as a diagnosis tool, suggesting that it could possibly be more useful for early detection. However, given that HbA1c may also have lower sensitivity and higher false positive rate, several diagnostic criteria should be used to diagnose diabetes accurately.

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