Haemoglobin A1c-based screening for prediabetes and diabetes mellitus: a multi-center study in Croatian adult
Ivana Lapić1, Dunja Rogić1,2, Nora Nikolac Gabaj2,3
1Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia.
Insights
Screening Croatian adults revealed that approximately one in five has impaired glucose metabolism, with a notable percentage having undiagnosed diabetes mellitus (DM). These findings highlight the need for increased diabetes prevention efforts in Croatia.
Area of Science:
- Endocrinology
- Public Health
- Clinical Diagnostics
Background:
- A significant proportion of adults may have prediabetes or undiagnosed diabetes mellitus (DM).
- Haemoglobin A1c (HbA1c) screening is a viable method for identifying glucose metabolism impairments.
- Understanding the prevalence of these conditions in Croatia is crucial for public health initiatives.
Purpose of the Study:
- To estimate the prevalence of prediabetes and undiagnosed diabetes mellitus (DM) in a Croatian adult cohort.
- To utilize haemoglobin A1c (HbA1c) screening for identifying glucose metabolism abnormalities.
- To assess the prevalence based on American Diabetes Association criteria.
Main Methods:
- A multi-center, cross-sectional study involving 5092 Croatian adults aged 40-70 years.
- Haemoglobin A1c (HbA1c) levels were measured using an enzymatic method.
- Prediabetes was defined as HbA1c 39-47 mmol/mol, and undiagnosed DM as HbA1c ≥ 48 mmol/mol.
Main Results:
- 17.3% of participants had prediabetes (HbA1c 39-47 mmol/mol).
- 4.2% of participants had undiagnosed diabetes mellitus (DM) (HbA1c ≥ 48 mmol/mol).
- Prevalence of prediabetes and undiagnosed DM increased with age, reaching 25.4% and 5.8% respectively in those aged 60-70 years.
Conclusions:
- About one in five adults in the studied cohort exhibited impaired glucose metabolism.
- A substantial number of individuals had undiagnosed diabetes mellitus (DM).
- These findings underscore the necessity for enhanced diabetes prevention strategies in Croatia.
Introduction:
Based on the hypothesis that there is a substantial rate of adults with prediabetes and undiagnosed diabetes mellitus (DM), our aim was to perform haemoglobin A1c (HbA1c)-based screening in a cohort of Croatian adults and estimate the prevalence of prediabetes and undiagnosed DM according to American Diabetes Association criteria.
Materials And Methods:
This multi-center, cross-sectional study performed in six Croatian hospitals included 5527 patients aged 40 to 70 years admitted to the Emergency Department or undergoing a primary care check-up. Haemoglobin A1c was measured from leftover whole blood samples using the enzymatic method on either Alinity c or Architect c-series analyser (Abbott Laboratories, Chicago, USA). Haemoglobin A1c between 39-47 mmol/mol was classified as prediabetes, while ≥ 48 mmol/mol as undiagnosed DM.
Results:
After exclusion of 435 patients with known DM, the final cohort included 5092 patients (median age 57; 56% males). A total of 882 (17.3%) patients had HbA1c values between 39 and 47 mmol/mol. There were 214 (4.2%) patients with HbA1c ≥ 48 mmol/mol. Prediabetes prevalence ranged from 14.2% to 20.5%, while undiagnosed DM from 3.3% to 7.3%, with statistically significant differences among settings (P < 0.001). Age-stratified analysis showed that prediabetes and undiagnosed DM prevalence increase with age (P < 0.001), being 25.4% and 5.8%, respectively, in patients aged 60 to 70 years.
Conclusion:
Underlying impairment of glucose metabolism was identified in about one in five adults, with significant number of patients with already overt DM. These results should serve as a starting point for further steps directed towards promotion of preventive measures for DM in Croatia.
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