Charumathi Sabanayagam1, Eric Y H Khoo, Weng Kit Lye, M Kamran Ikram, Ecosse L Lamoureux, Ching Yu Cheng, Maudrene L S Tan, Agus Salim, Jeannette Lee, Su-Chi Lim, Subramaniam Tavintharan, Ah-Chuan Thai, Derrick Heng, Stefan Ma, E Shyong Tai, Tien Y Wong. 1. Singapore Eye Research Institute (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.), Singapore 169856; Office of Clinical Sciences (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.), Duke-NUS Graduate Medical School, Singapore 169856; Departments of Ophthalmology (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.) and Medicine (E.Y.H.K., M.L.S.T., A.-C.T., E.S.T.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597; Center for Quantitative Medicine (W.K.L.), Duke-NUS Graduate Medical School, Singapore 169856; Department of Epidemiology and Public Health (A.S., J.L.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597; Department of Medicine (S.C.-L., S.T.), Khoo Teck Puat Hospital, Singapore 768828; and Epidemiology and Disease Control Division (D.H., S.M.), Ministry of Health, Singapore 169854.
Abstract
CONTEXT: Hemoglobin A1c (HbA1c) ≥ 6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians. OBJECTIVE: To examine the relationship between HbA1c and diabetes-specific moderate retinopathy in Asian ethnic groups. DESIGN, SETTING, AND PARTICIPANTS: Four independent population-based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n = 13 170 adults aged ≥ 25 y: Chinese, 5834; Malays, 3596; and Indians, 3740). MAIN OUTCOME: Moderate retinopathy was assessed from digital retinal photographs and defined as a level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for detecting moderate retinopathy were compared across ethnic groups at different HbA1c cut-points. RESULTS: HbA1c levels were higher in Indians and Malays compared to Chinese (P < .001). The prevalence of moderate retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥ 6.5%, the sensitivity for detecting moderate retinopathy was lower in Chinese subjects compared to Indians and Malays (75.8 vs 86.0 and 85.3%), but specificity (89.7 vs 71.9 and 76.3%) was higher; however, positive predictive value and negative predictive value were similar among Chinese, Indians, and Malays (10.5, 12.3, 12.4%; and 99.6, 99.1, 99.2%, respectively). The AUCs were similar across all three ethnic groups (0.861, 0.851, and 0.853). CONCLUSIONS: Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some interethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.
CONTEXT: Hemoglobin A1c (HbA1c) ≥ 6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians. OBJECTIVE: To examine the relationship between HbA1c and diabetes-specific moderate retinopathy in Asian ethnic groups. DESIGN, SETTING, AND PARTICIPANTS: Four independent population-based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n = 13 170 adults aged ≥ 25 y: Chinese, 5834; Malays, 3596; and Indians, 3740). MAIN OUTCOME: Moderate retinopathy was assessed from digital retinal photographs and defined as a level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for detecting moderate retinopathy were compared across ethnic groups at different HbA1c cut-points. RESULTS: HbA1c levels were higher in Indians and Malays compared to Chinese (P < .001). The prevalence of moderate retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥ 6.5%, the sensitivity for detecting moderate retinopathy was lower in Chinese subjects compared to Indians and Malays (75.8 vs 86.0 and 85.3%), but specificity (89.7 vs 71.9 and 76.3%) was higher; however, positive predictive value and negative predictive value were similar among Chinese, Indians, and Malays (10.5, 12.3, 12.4%; and 99.6, 99.1, 99.2%, respectively). The AUCs were similar across all three ethnic groups (0.861, 0.851, and 0.853). CONCLUSIONS: Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some interethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.
Authors: Christina M Parrinello; A Richey Sharrett; Nisa M Maruthur; Richard M Bergenstal; Morgan E Grams; Josef Coresh; Elizabeth Selvin Journal: Diabetes Care Date: 2015-12-17 Impact factor: 19.112
Authors: Tingjing Ke; Rajkumar Dorajoo; Yi Han; Chiea-Chuen Khor; Rob M van Dam; Jian-Min Yuan; Woon-Puay Koh; Jianjun Liu; Yik Ying Teo; Daniel Y T Goh; E Shyong Tai; Tien Yin Wong; Ching-Yu Cheng; Yechiel Friedlander; Chew-Kiat Heng Journal: Ann Hum Genet Date: 2016-09 Impact factor: 1.670
Authors: Gin Way Law; Hamid Rahmatullah Bin Abd Razak; Graham Seow-Hng Goh; Khai Cheong Wong; Hwei Chi Chong; Ngai Nung Lo; Seng Jin Yeo Journal: Asia Pac J Sports Med Arthrosc Rehabil Technol Date: 2019-01-03