Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban Black South Africans : the Durban diabetes study

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dc.contributor.authorHird, Thomas R.en_ZA
dc.contributor.authorPirie, Fraser J.en_ZA
dc.contributor.authorEsterhuizen, Tonya M.en_ZA
dc.contributor.authorO’Leary, Brianen_ZA
dc.contributor.authorMcCarthy, Mark I.en_ZA
dc.contributor.authorYoung, Elizabeth H.en_ZA
dc.contributor.authorSandhu, Manjinder S.en_ZA
dc.contributor.authorMotala, Ayesha A.en_ZA
dc.date.accessioned2017-10-10T09:22:41Z
dc.date.available2017-10-10T09:22:41Z
dc.date.issued2016
dc.descriptionCITATION: Hird, T. R., 2016. Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban Black South Africans : the Durban diabetes study. PLoS ONE, 11(8):e0161966, doi:10.1371/journal. pone.0161966.en_ZA
dc.descriptionThe original publication is available at http://journals.plos.org/plosoneen_ZA
dc.description.abstractObjective: Glycated haemoglobin (HbA1c) is recommended as an additional tool to glucose-based measures (fasting plasma glucose [FPG] and 2-hour plasma glucose [2PG] during oral glucose tolerance test [OGTT]) for the diagnosis of diabetes; however, its use in sub-Saharan African populations is not established. We assessed prevalence estimates and the diagnosis and detection of diabetes based on OGTT, FPG, and HbA1c in an urban black South African population. Research Design and Methods: We conducted a population-based cross-sectional survey using multistage cluster sampling of adults aged ≥18 years in Durban (eThekwini municipality), KwaZulu-Natal. All participants had a 75-g OGTT and HbA1c measurements. Receiver operating characteristic (ROC) analysis was used to assess the overall diagnostic accuracy of HbA1c, using OGTT as the reference, and to determine optimal HbA1c cut-offs. Results: Among 1190 participants (851 women, 92.6% response rate), the age-standardised prevalence of diabetes was 12.9% based on OGTT, 11.9% based on FPG, and 13.1% based on HbA1c. In participants without a previous history of diabetes (n = 1077), using OGTT as the reference, an HbA1c ≥48 mmol/mol (6.5%) detected diabetes with 70.3% sensitivity (95%CI 52.7–87.8) and 98.7% specificity (95%CI 97.9–99.4) (AUC 0.94 [95%CI 0.89–1.00]). Additional analyses suggested the optimal HbA1c cut-off for detection of diabetes in this population was 42 mmol/mol (6.0%) (sensitivity 89.2% [95%CI 78.6–99.8], specificity 92.0% [95%CI: 90.3–93.7]). Conclusions: In an urban black South African population, we found a high prevalence of diabetes and provide the first evidence for the utility of HbA1c for the diagnosis and detection of diabetes in black Africans in sub-Saharan Africa.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161966en_ZA
dc.description.versionPublisher's versionen_ZA
dc.format.extent12 pages : illustrationsen_ZA
dc.identifier.citationHird, T. R., 2016. Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban Black South Africans : the Durban diabetes study. PLoS ONE, 11(8):e0161966, doi:10.1371/journal. pone.0161966en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0161966
dc.identifier.urihttp://hdl.handle.net/10019.1/102304en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectDiabetes -- South Afirca -- Kwa-Zulu Natalen_ZA
dc.subjectDiabetes -- Diagnosisen_ZA
dc.subjectDiabetes -- Urban blacksen_ZA
dc.subjectDiabetes -- Risk factorsen_ZA
dc.titleBurden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban Black South Africans : the Durban diabetes studyen_ZA
dc.typeArticleen_ZA
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