Dalla Lana School of Public Health, Toronto, Ontario, Canada Public Health Ontario, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Public Health Ontario, Toronto, Ontario, Canada.
Diabetes Care. 2015 Jul;38(7):1299-305. doi: 10.2337/dc14-2474. Epub 2015 Apr 7.
To provide the first population-based estimates of prediabetes and undiagnosed type 2 diabetes prevalence in Canada.
We combined two fasting subsamples of the Canadian Health Measures Survey, which were restricted to nonpregnant adults ≥20 years of age (N = 3,494). Undiagnosed diabetes was defined as not having self-reported type 2 diabetes but having blood glucose measures that met Canadian guidelines (i.e., fasting plasma glucose [FPG] level of ≥7.0 mmol/L or hemoglobin A1c [HbA1c] level of ≥6.5% [≥48 mmol/mol]). Prediabetes was defined as an FPG level of ≥6.1 and <7.0 mmol/L or an HbA1c level of ≥6.0% and <6.5% (≥42 and <48 mmol/mol). All estimates were weighted using survey sampling weights. CIs were calculated with the bootstrap method.
According to FPG levels, the prevalence of undiagnosed type 2 diabetes in Canadian adults was 1.13% (95% CI 0.79, 1.62), contributing to ∼20% of total type 2 diabetes prevalence (5.62 [95% CI 4.52, 6.95]). Compared with FPG levels, the undiagnosed prevalence was greater using HbA1c level as a criterion (3.09% [95% CI 1.97, 4.81]), ∼41% of the total number of cases of diabetes (7.55 [95% CI 5.98, 9.49]). The HbA1c-only criterion resulted in a threefold increase in prediabetes prevalence overall and a sixfold increase among females (FPG 2.22%, HbA1c 13.31%). Screening based on FPG only identified older undiagnosed case patients, with a mean age of 58.7 years (95% CI 59.9, 63.4). Similarly, using HbA1c identified younger individuals with prediabetes, with reduced BMI and waist circumference compared with FPG levels.
In this first study of a nationally representative sample with biospecimen measures, we found that the prevalence of undiagnosed type 2 diabetes and prediabetes was significantly higher using HbA1c levels compared with FPG levels. Further evaluation is needed to fully assess the impact of using the HbA1c criterion.
提供加拿大糖尿病前期和未确诊 2 型糖尿病患病率的首个基于人群的估计值。
我们结合了加拿大健康测量调查的两个空腹亚样本，这些样本仅限于年龄≥20 岁的非孕妇成年人（N=3494）。未确诊的糖尿病定义为没有自我报告的 2 型糖尿病，但血糖测量符合加拿大指南（即空腹血浆葡萄糖[FPG]水平≥7.0mmol/L 或血红蛋白 A1c[HbA1c]水平≥6.5%[≥48mmol/mol]）。糖尿病前期定义为 FPG 水平≥6.1 且<7.0mmol/L 或 HbA1c 水平≥6.0%且<6.5%（≥42 且<48mmol/mol）。所有估计值均使用调查抽样权重进行加权。使用自举法计算置信区间。
根据 FPG 水平，加拿大成年人中未确诊的 2 型糖尿病患病率为 1.13%（95%CI0.79，1.62），占 2 型糖尿病总患病率的约 20%（5.62[95%CI4.52，6.95]）。与 FPG 水平相比，使用 HbA1c 水平作为标准时，未确诊的患病率更高（3.09%[95%CI1.97，4.81]），占糖尿病总病例数的约 41%（7.55[95%CI5.98，9.49]）。仅使用 HbA1c 标准会导致总体糖尿病前期患病率增加三倍，女性增加六倍（FPG2.22%，HbA1c13.31%）。仅基于 FPG 进行筛查会导致年龄较大的未确诊病例患者，平均年龄为 58.7 岁（95%CI59.9，63.4）。同样，使用 HbA1c 可识别出患有糖尿病前期的较年轻个体，与 FPG 水平相比，他们的 BMI 和腰围较低。
在这项针对具有生物样本测量的全国代表性样本的首次研究中，我们发现使用 HbA1c 水平与使用 FPG 水平相比，未确诊的 2 型糖尿病和糖尿病前期的患病率明显更高。需要进一步评估以充分评估使用 HbA1c 标准的影响。
