@article{fdi:010064901,
  title = {{E}ffects of diabetes definition on global surveillance of diabetes prevalence and diagnosis : a pooled analysis of 96 population-based studies with 331288 participants},
  author = {{D}anaei, {G}. and {F}ahimi, {S}. and {L}u, {Y}. and {Z}hou, {B}. and {H}ajifathalian, {K}. and {D}i {C}esare, {M}. and {L}o, {W}. {C}. and {R}eis-{S}antos, {B}. and {C}owan, {M}. {J}. and {S}haw, {J}. {E}. and {B}entham, {J}. and {L}in, {J}. {K}. and {B}ixby, {H}. and {M}agliano, {D}. and {B}ovet, {P}. and {M}iranda, {J}. {J}. and {K}hang, {Y}. {H}. and {S}tevens, {G}. {A}. and {R}iley, {L}. {M}. and {A}li, {M}. {K}. and {E}zzati, {M}. and {A}bdeen, {Z}. {A}. and {K}adir, {K}. {A}. and {T}raissac, {P}ierre and et al.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {D}iabetes has been defined on the basis of different biomarkers, including fasting plasma glucose ({FPG}), 2-h plasma glucose in an oral glucose tolerance test (2h{OGTT}), and {H}b{A}(1c). {W}e 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. {M}ethods {W}e used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. {D}iabetes was defined using {H}b{A}(1c) ({H}b{A}(1c) >= 6 . 5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either {FPG} only or {FPG}-or-2h{OGTT} definitions ({FPG} >= 7 . 0 mmol/{L} or 2h{OGTT} >= 11 . 1 mmol/{L} or history of diabetes or using insulin or oral hypoglycaemic drugs). {W}e calculated diabetes prevalence, taking into account complex survey design and survey sample weights. {W}e compared the prevalences of diabetes using different definitions graphically and by regression analyses. {W}e calculated sensitivity and specificity of diabetes diagnosis based on {H}b{A}1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). {W}e calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. {W}e assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. {F}indings {P}opulation prevalence of diabetes based on {FPG}- or-2h{OGTT} was correlated with prevalence based on {FPG} alone (r= 0 . 98), but was higher by 2-6 percentage points at different prevalence levels. {P}revalence based on {H}b{A}(1c) 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. {T}he variation across studies in the relation between glucose-based and {H}b{A}(1c)-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. {D}iabetes defined as {H}b{A}(1c) 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-2h{OGTT} was 30 . 5% (28 . 7-32 . 3%). {N}one of the preselected study-level characteristics explained the heterogeneity in the sensitivity of {H}b{A}(1c) versus {FPG}. {I}nterpretation {D}ifferent biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. {U}sing an {H}b{A}(1c)-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.},
  keywords = {},
  booktitle = {},
  journal = {{L}ancet {D}iabetes and {E}ndocrinology},
  volume = {3},
  numero = {8},
  pages = {624--637},
  ISSN = {2213-8587},
  year = {2015},
  DOI = {10.1016/s2213-8587(15)00129-1},
  URL = {https://www.documentation.ird.fr/hor/fdi:010064901},
}