Evaluation of Glycated Hemoglobin (HbA1c) for Diagnosing Type 2 Diabetes and Prediabetes among Palestinian Arab Population

The purpose of the study is to compare the potential of HbA1c to diagnose diabetes among Palestinian Arabs compared to fasting plasma glucose (FPG). A cross-sectional sample of 1370 Palestinian men (468) and women (902) without known diabetes and above the age of 30 years were recruited. Whole blood was used to estimate HbA1c and plasma for FPG and total lipid profile. Fasting plasma glucose was used as a reference to diagnose diabetes ($126 mg/dL) and prediabetes (100–125 mg/dL). The area under the receiver operating characteristic curve (AUC) for HbA1c was 81.9diabetes and 63.90.498) and low with prediabetes (K = 0.142). The optimal cut-off value for HbA1c to diagnose diabetes was$ 6.3% (45 mmol/mol). The sensitivity, specificity and the discriminant ability were 65.6% (53.1–76.3%), 94.5% (93.1–95.6%), 80.0% (72.8–87.3%), respectively. However, using cut-off value of $6.5the sensitivity, specificity and the discriminant ability were 57.4For diagnosing prediabetes with HbA1c between 5.7–6.4discriminant ability were 62.7value of$ 6.5% (48 mmol/mol) by itself diagnosed 5.3% and 48.3% as having diabetes and prediabetes compared to 4.5% and 24.2% using FPG, respectively. Mean HbA1c and FPG increase significantly with increasing body mass index. In conclusion, the ROC curves showed HbA1c could be used for diagnosing diabetes when compared to FPG but not for prediabetes in Palestinians Arabs even though only about 50% of the diabetic subjects were identified by the both HbA1c and FPG.This project was partially supported by United Nation Relief and Working Agency (UNRWA. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors thank Fida Zeidan from UNRWA for organizing the teams at different UNRWA clinics. Also, the authors thank the staff of UNRWA clinics for their cooperation in the study. Thanks to Dr. Khaldoun Bader from Al-Quds University for his assistance in statistical analysis.Guarantor: Akram T. Kharroubi

HbA_1c receiver operating characteristic (ROC) curves for diabetes (A) and prediabetes (B) using FPG as a reference.

<p>AUC: area under the receiver operating characteristic curve.</p

The difference between mean values of measured parameters between subjects with diabetes vs. normal subjects according to FPG and HbA_1c criteria.

<p>Diagnosed by FPG (cut-off value ≥126 mg/dL): N for diabetes  =  61, N for normal  =  1309</p><p>Diagnosed by HbA_1c (cut-off value ≥6.5%), N for diabetes  =  73, N for normal  =  1297</p><p>t test was used to compare means of diabetes vs. control.</p

Venn Diagrams for Diabetes, ADA standards.

<p>Diabetes diagnosed by HbA_1c ≥ 6.5% (48 mmol/mol, n = 73) or FPG ≥ 126 mg/dL (n = 61). Prediabetes diagnosed by HbA_1c 5.7–6.4% (39–46 mmol/mol, n = 628) or FPG 100–125 mg/dL (n = 337). Normal diagnosed by HbA_1c < 5.7% (39 mmol/mol, n = 669) or FPG <100 mg/dL (n = 972).</p

Total Antioxidant Status in Type 2 Diabetic Patients in Palestine

The objective of this study was to compare the level of total antioxidant status (TAS) in type 2 diabetic and normal Palestinian subjects as well as the major factors influencing TAS levels. A sample of convenience composed of 212 type 2 diabetic and 208 normal subjects above the age of 40 were recruited. Only 9.8% of the subjects had normal body mass index (BMI) levels (<25), 29% were overweight (≥25 to <30), and 61.2% were obese (≥30). The mean levels of TAS were significantly higher in diabetic compared to control subjects (2.18 versus 1.84 mM Trolox, P = 0.001) and in hypertensive subjects compared to subjects with normal blood pressure (BP). Mean TAS levels were higher in obese compared to nonobese subjects (2.12 versus 1.85 mM Trolox, P = 0.001). Mean TAS levels were similarly higher in subjects with high fasting plasma glucose (FPG) compared to normal FPG (2.19 versus 1.90 mM Trolox) and high HbA1c (≥6.5%) compared to HbA1c < 6.5% (2.14 versus 1.91 mM Trolox). Multivariate analysis revealed that only diabetic status (P = 0.032) and the level of education (P = 0.036) were significantly associated with TAS. In conclusion diabetic patients had 18.5% increase in TAS levels compared to control subjects