Concordance Between Fasting Plasma Glucose And Hba(1c) In The Diagnosis Of Diabetes In Black South African Adults: A Cross-Sectional Study

Objectives We investigated concordance between haemoglobin A1c (HbA(1)c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity. Design Cross-sectional study. Setting Rural South African population-based cohort. Participants 765 black individuals aged 40-70 years and with no history of diabetes. Primary and secondary outcome measures The primary outcome measure was concordance between HbA(1c)-defined diabetes and FPG-defined diabetes. Secondary outcome measures were differences in anthropometric characteristics, fat distribution and insulin resistance (measured using Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR)) between those with concordant and discordant HbA(1c)/FPG classifications and predictors of HbA(1c) variance. Results The prevalence of HbA(1c)-defined diabetes was four times the prevalence of FPG-defined diabetes (17.5% vs 4.2%). Classification was discordant in 15.7% of participants, with 111 individuals (14.5%) having HbA(1c)-only diabetes (kappa 0.23; 95% CI 0.14 to 0.31). Median body mass index, waist and hip circumference, waist-to-hip ratio, subcutaneous adipose tissue and HOMA-IR in participants with HbA(1c)-only diabetes were similar to those in participants who were normoglycaemic by both biomarkers and significantly lower than in participants with diabetes by both biomarkers (p<0.05). HOMA-IR and fat distribution explained additional HbA(1c) variance beyond glucose and age only in women. Conclusions Concordance was poor between HbA(1c) and FPG in diagnosis of diabetes in black South Africans, and participants with HbA(1c)-only diabetes phenotypically resembled normoglycaemic participants. Further work is necessary to determine which of these parameters better predicts diabetes-related morbidities in this population and whether a population-specific HbA(1c) threshold is necessary.