Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c
Authors:   NCD Risk Factor Collaboration (NCD-RisC), Zhou Bin , Sheffer Kate E. , Bennett James E. , Gregg Edward W. , Danaei Goodarz , Singleton Rosie K. , Shaw Jonathan E. , Mishra Anu , Lhoste Victor P. F. , Carrillo-Larco Rodrigo M. , Kengne Andre P. , Phelps Nowell H. , Heap Rachel A. , Rayner Archie W. , Stevens Gretchen A. , Paciorek Chris J. , Riley Leanne M. , Cowan Melanie J. , Savin Stefan , Vander Hoorn Stephen , Lu Yuan , Pavkov Meda E. , Imperatore Giuseppina , Aguilar-Salinas Carlos A. , Ahmad Noor Ani , Anjana Ranjit Mohan , Davletov Kairat , Farzadfar Farshad , González-Villalpando Clicerio , Khang Young-Ho , Kim Hyeon Chang , Laatikainen Tiina , Laxmaiah Avula , Mbanya Jean Claude N. , Narayan K. M. Venkat , Ramachandran Ambady , Wade Alisha N. , Zdrojewski Tomasz , Abbasi-Kangevari Mohsen , Rahim Hanan F. Abdul , Abu-Rmeileh Niveen M. , Adambekov Shalkar , Adams Robert J. , Aekplakorn Wichai , Agdeppa Imelda A. , Aghazadeh-Attari Javad , Agyemang Charles , Ahmadi Ali , Ahmadi Naser , Ahmadi Nastaran , Ahmed Soheir H. , Ajlouni Kamel , Al-Hinai Halima , Al-Lahou Badreya , Al-Lawati Jawad A. , Asfoor Deena Al , Al Qaoud Nawal M. , Alarouj Monira , AlBuhairan Fadia , AlDhukair Shahla , Aldwairji Maryam A. , Ali Mohamed M. , Alinezhad Farbod , Alkandari Abdullah , Alomirah Husam F. , Aly Eman , Amarapurkar Deepak N. , Andersen Lars Bo , Anderssen Sigmund A. , Andrade Dolores S. , Ansari-Moghaddam Alireza , Aounallah-Skhiri Hajer , Aris Tahir , Arlappa Nimmathota , Aryal Krishna K. , Assah Felix K. , Assembekov Batyrbek , Auvinen Juha , Avdičová Mária , Azad Kishwar , Azimi-Nezhad Mohsen , Azizi Fereidoun , Bacopoulou Flora , Balakrishna Nagalla , Bamoshmoosh Mohamed , Banach Maciej , Bandosz Piotr , Banegas José R. , Barbagallo Carlo M. , Barceló Alberto , Baretić Maja , Barrera Lena , Basit Abdul , Batieha Anwar M. , Batista Aline P. , Baur Louise A. , Belavendra Antonisamy , Ben Romdhane Habiba , Benet Mikhail , Berkinbayev Salim , Bernabe-Ortiz Antonio , Berrios Carrasola Ximena , Bettiol Heloísa , Beybey Augustin F. , Bhargava Santosh K. , Bika Lele Elysée Claude , Bikbov Mukharram M. , Bista Bihungum , Bjerregaard Peter , Bjertness Espen , Bjertness Marius B. , Björkelund Cecilia , Bloch Katia V. , Blokstra Anneke , Bo Simona , Bobak Martin , Boggia Jose G. , Bonaccio Marialaura , Bonilla-Vargas Alice , Borghs Herman , Bovet Pascal , Brajkovich Imperia , Brenner Hermann , Brewster Lizzy M. , Brian Garry R. , Briceño Yajaira , Brito Miguel , Bugge Anna , Buntinx Frank , Cabrera de León Antonio , Caixeta Roberta B. , Can Günay , Cândido Ana Paula C. , Capanzana Mario V. , Čapková Naděžda , Capuano Eduardo , Capuano Rocco , Capuano Vincenzo , Cardoso Viviane C. , Carlsson Axel C. , Casanueva Felipe F. , Censi Laura , Cervantes‐Loaiza Marvin , Chamnan Parinya , Chamukuttan Snehalatha , Chan Queenie , Charchar Fadi J. , Chaturvedi Nish , Chen Huashuai , Cheraghian Bahman , Chirlaque María-Dolores , Chudek Jerzy , Cifkova Renata , Cirillo Massimo , Claessens Frank , Cohen Emmanuel , Concin Hans , Cooper Cyrus , Costanzo Simona , Cowell Chris , Crujeiras Ana B. , Cruz Juan J. , Cureau Felipe V. , Cuschieri Sarah , D’Arrigo Graziella , d’Orsi Eleonora , Dallongeville Jean , Damasceno Albertino , Dastgiri Saeed , De Curtis Amalia , de Gaetano Giovanni , De Henauw Stefaan , Deepa Mohan , DeGennaro Vincent , Demarest Stefaan , Dennison Elaine , Deschamps Valérie , Dhimal Meghnath , Dika Zivka , Djalalinia Shirin , Donfrancesco Chiara , Dong Guanghui , Dorobantu Maria , Dörr Marcus , Dragano Nico , Drygas Wojciech , Du Yong , Duante Charmaine A. , Duboz Priscilla , Dushpanova Anar , Dziankowska-Zaborszczyk Elzbieta , Ebrahimi Narges , Eddie Ricky , Eftekhar Ebrahim , Efthymiou Vasiliki , Egbagbe Eruke E. , Eghtesad Sareh , El-Khateeb Mohammad , El Ati Jalila , Eldemire-Shearer Denise , Elosua Roberto , Enang Ofem , Erasmus Rajiv T. , Erbel Raimund , Erem Cihangir , Ergor Gul , Eriksen Louise , Eriksson Johan G. , Esmaeili Ali , Evans Roger G. , Fakhradiyev Ildar , Fall Caroline H. , Faramarzi Elnaz , Farjam Mojtaba , Farzi Yosef , Fattahi Mohammad Reza , Fawwad Asher , Felix-Redondo Francisco J. , Ferguson Trevor S. , Fernández-Bergés Daniel , Ferrari Marika , Ferreccio Catterina , Ferreira Haroldo S. , Ferrer Eldridge , Feskens Edith J. M. , Flood David , Forsner Maria , Fosse Sandrine , Fottrell Edward F. , Fouad Heba M. , Francis Damian K. , Frontera Guillermo , Furusawa Takuro , Gaciong Zbigniew , Garnett Sarah P. , Gasull Magda , Gazzinelli Andrea , Gehring Ulrike , Ghaderi Ebrahim , Ghamari Seyyed-Hadi , Ghanbari Ali , Ghasemi Erfan , Gheorghe-Fronea Oana-Florentina , Ghimire Anup , Gialluisi Alessandro , Giampaoli Simona , Gianfagna Francesco , Gill Tiffany K. , Gironella Glen , Giwercman Aleksander , Goltzman David , Gomula Aleksandra , Gonçalves Helen , Gonçalves Mauer , Gonzalez-Chica David A. , Gonzalez-Gross Marcela , González-Rivas Juan P. , González-Villalpando María-Elena , Gonzalez Angel R. , Gottrand Frederic , Grafnetter Dušan , Grodzicki Tomasz , Grøntved Anders , Guerrero Ramiro , Gujral Unjali P. , Gupta Rajeev , Gutierrez Laura , Gwee Xinyi , Haghshenas Rosa , Hakimi Hamid , Hambleton Ian R. , Hamzeh Behrooz , Hanekom Willem A. , Hange Dominique , Hantunen Sari , Hao Jie , Hari Kumar Rachakulla , Harooni Javad , Hashemi-Shahri Seyed Mohammad , Hata Jun , Heidemann Christin , Henrique Rafael dos Santos , Herrala Sauli , Herzig Karl-Heinz , Heshmat Ramin , Ho Sai Yin , Holdsworth Michelle , Homayounfar Reza , Hopman Wilma M. , Horimoto Andrea R. V. R. , Hormiga Claudia , Horta Bernardo L. , Houti Leila , Howitt Christina , Htay Thein Thein , Htet Aung Soe , Htike Maung Maung Than , Huerta José María , Huhtaniemi Ilpo Tapani , Huisman Martijn , Husseini Abdullatif , Huybrechts Inge , Iacoviello Licia , Iakupova Ellina M. , Iannone Anna G. , Ibrahim Wong Norazizah , Ijoma Chinwuba , Irazola Vilma E. , Ishida Takafumi , Isiguzo Godsent C. , Islam Sheikh Mohammed Shariful , Islek Duygu , Ittermann Till , Iwasaki Masanori , Jääskeläinen Tuija , Jacobs Jeremy M. , Jaddou Hashem Y. , Jadoul Michel , Jallow Bakary , James Kenneth , Jamil Kazi M. , Janus Edward , Jarvelin Marjo-Riitta , Jasienska Grazyna , Jelaković Ana , Jelaković Bojan , Jennings Garry , Jha Anjani Kumar , Jimenez Ramon O. , Jöckel Karl-Heinz , Jokelainen Jari J. , Jonas Jost B. , Joshi Pradeep , Josipović Josipa , Joukar Farahnaz , Jóźwiak Jacek , Kafatos Anthony , Kajantie Eero O. , Kalmatayeva Zhanna , Karki Khem B. , Katibeh Marzieh , Kauhanen Jussi , Kazakbaeva Gyulli M. , Kaze François F. , Ke Calvin , Keinänen-Kiukaanniemi Sirkka , Kelishadi Roya , Keramati Maryam , Kersting Mathilde , Khader Yousef Saleh , Khaledifar Arsalan , Khalili Davood , Kheiri Bahareh , Kheradmand Motahareh , Khosravi Alireza , Kiechl-Kohlendorfer Ursula , Kiechl Sophia J. , Kiechl Stefan , Kingston Andrew , Klakk Heidi , Klanova Jana , Knoflach Michael , Kolsteren Patrick , König Jürgen , Korpelainen Raija , Korrovits Paul , Kos Jelena , Koskinen Seppo , Kowlessur Sudhir , Koziel Slawomir , Kriemler Susi , Kristensen Peter Lund , Kromhout Daan , Kubinova Ruzena , Kujala Urho M. , Kulimbet Mukhtar , Kurjata Pawel , Kyobutungi Catherine , La Quang Ngoc , Labadarios Demetre , Lachat Carl , Laid Youcef , Lall Lachmie , Lankila Tiina , Lanska Vera , Lappas Georg , Larijani Bagher , Latt Tint Swe , Laurenzi Martino , Lehmann Nils , Lehtimäki Terho , Lemogoum Daniel , Leung Gabriel M. , Li Yanping , Lima-Costa M. Fernanda , Lin Hsien-Ho , Lind Lars , Lissner Lauren , Liu Xiaotian , Lopez-Garcia Esther , Lopez Tania , Lozano José Eugenio , Luksiene Dalia , Lundqvist Annamari , Lunet Nuno , Lustigová Michala , Machado-Coelho George L. L. , Machado-Rodrigues Aristides M. , Macia Enguerran , Macieira Luisa M. , Madar Ahmed A. , Maestre Gladys E. , Maggi Stefania , Magliano Dianna J. , Magriplis Emmanuella , Mahasampath Gowri , Maire Bernard , Makdisse Marcia , Malekpour Mohammad-Reza , Malekzadeh Fatemeh , Malekzadeh Reza , Mallikharjuna Rao Kodavanti , Malyutina Sofia , Maniego Lynell V. , Manios Yannis , Mannix Masimango Imani , Mansour-Ghanaei Fariborz , Manzato Enzo , Margozzini Paula , Mariño Joany , Marques Larissa Pruner , Martorell Reynaldo , Mascarenhas Luis P. , Masinaei Masoud , Mathiesen Ellisiv B. , Matsha Tandi E. , Mc Donald Posso Anselmo J. , McFarlane Shelly R. , McGarvey Stephen T. , Mediene Benchekor Sounnia , Mehlig Kirsten , Mehrparvar Amir Houshang , Melgarejo Jesus D. , Méndez Fabián , Menezes Ana Maria B. , Mereke Alibek , Meshram Indrapal I. , Meto Diane T. , Minderico Cláudia S. , Mini G. K. , Miquel Juan Francisco , Miranda J. Jaime , Mirjalili Mohammad Reza , Modesti Pietro A. , Moghaddam Sahar Saeedi , Mohamed Mostafa K. , Mohammad Kazem , Mohammadi Mohammad Reza , Mohammadi Zahra , Mohammadifard Noushin , Mohammadpourhodki Reza , Mohan Viswanathan , Mohd Yusoff Muhammad Fadhli , Mohebbi Iraj , Møller Niels C. , Molnár Dénes , Momenan Amirabbas , Mondo Charles K. , Montenegro Mendoza Roger A. , Monterrubio-Flores Eric , Moosazadeh Mahmood , Moradpour Farhad , Morejon Alain , Moreno Luis A. , Morgan Karen , Morin Suzanne N. , Moslem Alireza , Mosquera Mildrey , Mossakowska Malgorzata , Mostafa Aya , Mostafavi Seyed-Ali , Motlagh Mohammad Esmaeel , Motta Jorge , Msyamboza Kelias P. , Mu Thet Thet , Muiesan Maria L. , Mursu Jaakko , Musa Kamarul Imran , Mustafa Norlaila , Muyer Muel Telo M. C. , Nabipour Iraj , Nagel Gabriele , Naidu Balkish M. , Najafi Farid , Námešná Jana , Nangia Vinay B. , Naseri Take , Neelapaichit Nareemarn , Nejatizadeh Azim , Nenko Ilona , Nervi Flavio , Ng Tze Pin , Nguyen Chung T. , Nguyen Quang Ngoc , Ni Michael Y. , Nie Peng , Nieto-Martínez Ramfis E. , Ninomiya Toshiharu , Noale Marianna , Noboa Oscar A. , Noto Davide , Nsour Mohannad Al , Nuhoğlu Irfan , O’Neill Terence W. , Odili Augustine N. , Oh Kyungwon , Ohtsuka Ryutaro , Omar Mohd Azahadi , Onat Altan , Ong Sok King , Onodugo Obinna , Ordunez Pedro , Ornelas Rui , Ortiz Pedro J. , Osmond Clive , Ostovar Afshin , Otero Johanna A. , Ottendahl Charlotte B. , Otu Akaninyene , Owusu-Dabo Ellis , Palmieri Luigi , Pan Wen-Harn , Panda-Jonas Songhomitra , Panza Francesco , Paoli Mariela , Park Suyeon , Parsaeian Mahboubeh , Patel Nikhil D. , Pechlaner Raimund , Pećin Ivan , Pedro João M. , Peixoto Sergio Viana , Peltonen Markku , Pereira Alexandre C. , Pessôa dos Prazeres Thaliane Mayara , Peykari Niloofar , Phall Modou Cheyassin , Pham Son Thai , Phan Hiep Hoang , Pichardo Rafael N. , Pikhart Hynek , Pilav Aida , Piler Pavel , Pitakaka Freda , Piwonska Aleksandra , Pizarro Andreia N. , Plans-Rubió Pedro , Plata Silvia , Porta Miquel , Poudyal Anil , Pourfarzi Farhad , Pourshams Akram , Poustchi Hossein , Pradeepa Rajendra , Providencia Rui , Puder Jardena J. , Puhakka Solie , Punab Margus , Qorbani Mostafa , Quintana Hedley K. , Quoc Bao Tran , Rahimikazerooni Salar , Raitakari Olli , Ramirez-Zea Manuel , Ramke Jacqueline , Ramos Rafel , Rampal Lekhraj , Rampal Sanjay , Rangel Reina Daniel A. , Rashidi Mohammad-Mahdi , Redon Josep , Renner Jane D. P. , Reuter Cézane P. , Revilla Luis , Rezaei Negar , Rezaianzadeh Abbas , Rigo Fernando , Roa Reina G. , Robinson Louise , Rodríguez-Artalejo Fernando , Rodriguez-Perez María del Cristo , Rodríguez-Villamizar Laura A. , Rodríguez Andrea Y. , Roggenbuck Ulla , Rohloff Peter , Romeo Elisabetta L. , Rosengren Annika , Rubinstein Adolfo , Rust Petra , Rutkowski Marcin , Sabbaghi Hamideh , Sachdev Harshpal S. , Sadjadi Alireza , Safarpour Ali Reza , Safi Sare , Safiri Saeid , Saghi Mohammad Hossien , Saidi Olfa , Saki Nader , Šalaj Sanja , Salanave Benoit , Salonen Jukka T. , Salvetti Massimo , Sánchez-Abanto Jose , Santos Diana A. , Santos Lèlita C. , Santos Maria Paula , Santos Tamara R. , Saramies Jouko L. , Sardinha Luis B. , Sarrafzadegan Nizal , Saum Kai-Uwe , Sbaraini Mariana , Scazufca Marcia , Schaan Beatriz D. , Scheidt-Nave Christa , Schipf Sabine , Schmidt Carsten O. , Schöttker Ben , Schramm Sara , Sebert Sylvain , Sedaghattalab Moslem , Sein Aye Aye , Sepanlou Sadaf G. , Sewpaul Ronel , Shamah-Levy Teresa , Shamshirgaran Seyed Morteza , Sharafkhah Maryam , Sharma Sanjib K. , Sharman Almaz , Shayanrad Amaneh , Shayesteh Ali Akbar , Shimizu-Furusawa Hana , Shiri Rahman , Shrestha Namuna , Si-Ramlee Khairil , Silva Diego Augusto Santos , Simon Mary , Simons Judith , Simons Leon A. , Sjöström Michael , Slowikowska-Hilczer Jolanta , Slusarczyk Przemysław , Smeeth Liam , Sobngwi Eugène , Söderberg Stefan , Soemantri Agustinus , Sofat Reecha , Solfrizzi Vincenzo , Somi Mohammad Hossein , Soumaré Aïcha , Sousa-Poza Alfonso , Sparrenberger Karen , Staessen Jan A. , Stavreski Bill , Steene-Johannessen Jostein , Stehle Peter , Stein Aryeh D. , Stessman Jochanan , Stokwiszewski Jakub , Stronks Karien , Suarez-Ortegón Milton F. , Suebsamran Phalakorn , Sundström Johan , Suriyawongpaisal Paibul , Sylva René Charles , Szklo Moyses , Tamosiunas Abdonas , Tarawneh Mohammed Rasoul , Tarqui-Mamani Carolina B. , Taylor Anne , Taylor Julie , Tello Tania , Thankappan K. R. , Theobald Holger , Theodoridis Xenophon , Thomas Nihal , Thrift Amanda G. , Timmermans Erik J. , Tjandrarini Dwi Hapsari , Tolonen Hanna K. , Tolstrup Janne S. , Tomaszewski Maciej , Topbas Murat , Torres-Collado Laura , Traissac Pierre , Triantafyllou Areti , Tuitele John , Tuliakova Azaliia M. , Tulloch-Reid Marshall K. , Tuomainen Tomi-Pekka , Tzala Evangelia , Tzourio Christophe , Ueda Peter , Ugel Eunice , Ukoli Flora A. M. , Ulmer Hanno , Uusitalo Hannu M. T. , Valdivia Gonzalo , van den Born Bert-Jan , Van der Heyden Johan , Van Minh Hoang , van Rossem Lenie , Van Schoor Natasja M. , van Valkengoed Irene G. M. , van Zutphen Elisabeth M. , Vanderschueren Dirk , Vanuzzo Diego , Vasan Senthil K. , Vega Tomas , Velasquez-Melendez Gustavo , Verstraeten Roosmarijn , Viet Lucie , Villalpando Salvador , Vioque Jesus , Virtanen Jyrki K. , Viswanathan Bharathi , Voutilainen Ari , Wan Bebakar Wan Mohamad , Wan Mohamud Wan Nazaimoon , Wang Chongjian , Wang Ningli , Wang Qian , Wang Ya Xing , Wang Ying-Wei , Wannamethee S. Goya , Webster-Kerr Karen , Wedderkopp Niels , Wei Wenbin , Westbury Leo D. , Whincup Peter H. , Widhalm Kurt , Widyahening Indah S. , Więcek Andrzej , Wilks Rainford J. , Willeit Johann , Willeit Peter , Wilsgaard Tom , Wojtyniak Bogdan , Wong Andrew , Wong Emily B. , Woodward Mark , Wu Frederick C. , Xu Haiquan , Xu Liang , Yaacob Nor Azwany , Yan Li , Yan Weili , Yoosefi Moein , Yoshihara Akihiro , Younger-Coleman Novie O. , Yu Yu-Ling , Yu Yunjiang , Yusoff Ahmad Faudzi , Zainuddin Ahmad A. , Zamani Farhad , Zambon Sabina , Zampelas Antonis , Zaw Ko Ko , Zeljkovic Vrkic Tajana , Zeng Yi , Zhang Zhen-Yu , Zholdin Bekbolat , Zimmet Paul , Zitt Emanuel , Zoghlami Nada , Zuñiga Cisneros Julio , Ezzati Majid 
Published: November 2023

AbstractFasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.