Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants

Goodarz Danaei, Saman Fahimi, Yuan Lu, Bin Zhou, Kaveh Hajifathalian, Mariachiara Di Cesare, Wei Cheng Lo, Barbara Reis-Santos, Melanie J. Cowan, Jonathan E. Shaw, James Bentham, John K. Lin, Honor Bixby, Dianna Magliano, Pascal Bovet, J. Jaime Miranda, Young Ho Khang, Gretchen A. Stevens, Leanne M. Riley, Mohammed K. AliMajid Ezzati, Khalid Abdul Kadir, Niveen M. Abu-Rmeileh, Benjamin Acosta-Cazares, Wichai Aekplakorn, Carlos A. Aguilar-Salinas, Alireza Ahmadvand, Mohannad Al Nsour, Ala'a Alkerwi, Philippe Amouyel, Lars Bo Andersen, Sigmund A. Anderssen, Dolores S. Andrade, Ranjit Mohan Anjana, Hajer Aounallah-Skhiri, Tahir Aris, Nimmathota Arlappa, Dominique Arveiler, Felix K. Assah, Mária Avdicová, Nagalla Balakrishna, Piotr Bandosz, Carlo M. Barbagallo, Barceló Alberto Barceló, Anwar M. Batieha, Louise A. Baur, Habiba Ben Romdhane, Antonio Bernabe-Ortiz, Santosh K. Bhargava, Yufang Bi, Peter Bjerregaard, Cecilia Björkelund, Margaret Blake, Anneke Blokstra, Simona Bo, Bernhard O. Boehm, Carlos P. Boissonnet, Imperia Brajkovich, Juergen Breckenkamp, Lizzy M. Brewster, Garry R. Brian, Graziella Bruno, Anna Bugge, Antonio Cabrera de León, Gunay Can, Ana Paula C. Cândido, Vincenzo Capuano, Maria J. Carvalho, Felipe F. Casanueva, Carmelo A. Caserta, Katia Castetbon, Snehalatha Chamukuttan, Nishi Chaturvedi, Chien Jen Chen, Fangfang Chen, Shuohua Chen, Ching Yu Cheng, Angela Chetrit, Shu Ti Chiou, Yumi Cho, Jerzy Chudek, Renata Cifkova, Frank Claessens, Hans Concin, Cyrus Cooper, Rachel Cooper, Simona Costanzo, Dominique Cottel, Chris Cowell, Ana B. Crujeiras, Graziella D'Arrigo, Jean Dallongeville, Rachel Dankner, Luc Dauchet, Giovanni de Gaetano, Stefaan de Henauw, Mohan Deepa, Abbas Dehghan, Klodian Dhana, Augusto F. Di Castelnuovo, Shirin Djalalinia, Kouamelan Doua, Wojciech Drygas, Yong Du, Eruke E. Egbagbe, Robert Eggertsen, Jalila El Ati, Roberto Elosua, Rajiv T. Erasmus, Cihangir Erem, Gul Ergor, Louise Eriksen, Jorge Escobedo-de la Peña, Caroline H. Fall, Farshad Farzadfar, Francisco J. Felix-Redondo, Trevor S. Ferguson, Daniel Fernández-Bergés, Marika Ferrari, Catterina Ferreccio, Joseph D. Finn, Bernhard Föger, Leng Huat Foo, Heba M. Fouad, Damian K. Francis, Maria do Carmo Franco, Oscar H. Franco, Guillermo Frontera, Takuro Furusawa, Zbigniew Gaciong, Andrzej Galbarczyk, Sarah P. Garnett, Jean Michel Gaspoz, Magda Gasull, Louise Gates, Johanna M. Geleijnse, Anoosheh Ghasemain, Simona Giampaoli, Francesco Gianfagna, Jonathan Giovannelli, Marcela Gonzalez Gross, Juan P. González Rivas, Mariano Bonet Gorbea, Frederic Gottrand, Janet F. Grant, Tomasz Grodzicki, Anders Grøntved, Grabriella Gruden, Dongfeng Gu, Ong Peng Guan, Ramiro Guerrero, Idris Guessous, Andre L. Guimaraes, Laura Gutierrez, Rebecca Hardy, Rachakulla Hari Kumar, Jiang He, Christin Heidemann, Ilpo Tapani Hihtaniemi, Sai Yin Ho, Suzanne C. Ho, Albert Hofman, Andrea R.V. Russo Horimoto, Claudia M. Hormiga, Bernardo L. Horta, Leila Houti, Abdullatif S. Hussieni, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G. Iannone, Mohsen M. Ibrahim, Nayu Ikeda, Arfan M. Ikram, Vilma E. Irazola, Muhammad Islam, Masanori Iwasaki, Jeremy M. Jacobs, Tazeen Jafar, Grazyna Jasienska, Chao Qiang Jiang, Jost B. Jonas, Pradeep Joshi, Anthony Kafatos, Ofra Kalter-Leibovici, Amir Kasaeian, Joanne Katz, Prabhdeep Kaur, Maryam Kavousi, Roya Kelishadi, Andre P. Kengne, Mathilde Kersting, Yousef Saleh Khader, Stefan Kiechl, Jeongseon Kim, Yutaka Kiyohara, Patrick Kolsteren, Paul Korrovits, Seppo Koskinen, Wolfgang Kratzer, Daan Kromhout, Krzysztof Kula, Pawel Kurjata, Catherine Kyobutungi, Carl Lachat, Youcef Laid, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Avula Laxmaiah, Catherine Leclercq, Jeannette Lee, Jeonghee Lee, Terho Lehtimäki, Lekhraj Rampal, Luz M. León-Muñoz, Yanping Li, Wei Yen Lim, M. Fernanda Lima-Costa, Hsien Ho Lin, Xu Lin, Lauren Lissner, Roberto Lorbeer, José Eugenio Lozano, Annamari Lundqvist, Per Lytsy, Guansheng Ma, George L.L. Machado-Coelho, Suka Machi, Stefania Maggi, Marcia Makdisse, Kodavanti Mallikharjuna Rao, Yannis Manios, Enzo Manzato, Paula Margozzini, Pedro Marques-Vidal, Reynaldo Martorell, Shariq R. Masoodi, Tandi E. Matsha, Jean Claude N. Mbanya, Shelly R. McFarlane, Stephen T. McGarvey, Stela McLachlan, Breige A. McNulty, Sounnia Mediene-Benchekor, Aline Meirhaeghe, Ana Maria B. Menezes, Shahin Merat, Indrapal I. Meshram, Jie Mi, Juan Francisco Miquel, Mostafa K. Mohamed, Kazem Mohammad, Viswanathan Mohan, Muhammad Fadhli Mohd Yusoff, Niels C. Moller, Denes Molnar, Charles K. Mondo, Luis A. Moreno, Karen Morgan, George Moschonis, Malgorzata Mossakowska, Aya Mostafa, Jorge Mota, Maria L. Muiesan, Martina Müller-Nurasyid, Jaakko Mursu, Gabriele Nagel, Jana Namesna, Ei Ei K. Nang, Vinay B. Nangia, Eva Maria Navarrete-Muñoz, Ndeye Coumba Ndiaye, Flavio Nervi, Nguyen D. Nguyen, Ramfis E. Nieto-Martínez, Guang Ning, Toshiharu Ninomiya, Marianna Noale, Davide Noto, Angélica M. Ochoa-Avilés, Kyungwon Oh, Altan Onat, Clive Osmond, Johanna A. Otero, Luigi Palmieri, Songhomitra Panda-Jonas, Francesco Panza, Mahboubeh Parsaeian, Sergio Viana Peixoto, Alexandre C. Pereira, Annette Peters, Niloofar Peykari, Aida Pilav, Freda Pitakaka, Aleksandra Piwonska, Jerzy Piwonski, Pedro Plans-Rubió, Miquel Porta, Marileen L.P. Portegies, Hossein Poustchi, Rajendra Pradeepa, Jacqueline F. Price, Margus Punab, Radwan F. Qasrawi, Mostafa Qorbani, Olli Raitakari, Sudha Ramachandra Rao, Ambady Ramachandran, Rafel Ramos, Sanjay Rampal, Wolfgang Rathmann, Josep Redon, Paul Ferdinand M. Reganit, Fernando Rigo, Sian M. Robinson, Cynthia Robitaille, Laura A. Rodríguez, Fernando Rodríguez-Artalejo, María del Cristo Rodriguez-Perez, Rosalba Rojas-Martinez, Dora Romaguera, Annika Rosengren, Adolfo Rubinstein, Ornelas Rui, Blanca Sandra Ruiz-Betancourt, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S. Sachdev, Olfa Saidi, Sibel Sakarya, Benoit Salanave, Jukka T. Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Renata Nunes dos Santos, Rute Santos, Luis B. Sardinha, Marcia Scazufca, Herman Schargrodsky, Christa Scheidt-Nave, Kenji Shibuya, Youchan Shin, Rahman Shiri, Rosalynn Siantar, Abla M. Sibai, Mary Simon, Judith Simons, Leon A. Simons, Michael Sjostrom, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Marieke B. Snijder, Vincenzo Solfrizzi, Emily Sonestedt, Aicha Soumare, Jan A. Staessen, Jostein Steene-Johannessen, Peter Stehle, Aryeh D. Stein, Jochanan Stessman, Doris Stöckl, Jakub Stokwiszewski, Maria Wany Strufaldi, Chien An Sun, Johan Sundström, Paibul Suriyawongpaisal, Rody G. Sy, E. Shyong Tai, Mohammed Tarawneh, Carolina B. Tarqui-Mamani, Lutgarde Thijs, Janne S. Tolstrup, Murat Topbas, Maties Torrent, Pierre Traissac, Oanh T.H. Trinh, Marshall K. Tulloch-Reid, Tomi Pekka Tuomainen, Maria L. Turley, Christophe Tzourio, Peter Ueda, Flora M. Ukoli, Hanno Ulmer, Gonzalo Valdivia, Irene G.M. van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Tomas Vega, Gustavo Velasquez-Melendez, Giovanni Veronesi, Monique Verschuren, Jesus Vioque, Jyrki Virtanen, Sophie Visvikis-Siest, Bharathi Viswanathan, Peter Vollenweider, Sari Voutilainen, Alisha N. Wade, Aline Wagner, Janette Walton, Wan Nazaimoon Wan Mohamud, Ming Dong Wang, Ya Xing Wang, S. Goya Wannamethee, Deepa Weerasekera, Peter H. Whincup, Kurt Widhalm, Andrzej Wiecek, Rainford J. Wilks, Johann Willeit, Bogdan Wojtyniak, Tien Yin Wong, Jean Woo, Mark Woodward, Aleksander Giwercman Wu, Frederick C. Wu, Shou Ling Wu, Haiquan Xu, Xiaoguang Yang, Xingwang Ye, Akihiro Yoshihara, Novie O. Younger-Coleman, Sabina Zambon, Abdul Hamid Zargar, Tomasz Zdrojewski, Wenhua Zhao, Yingfeng Zheng

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.

Original languageEnglish
Pages (from-to)624-637
Number of pages14
JournalThe Lancet Diabetes and Endocrinology
Volume3
Issue number8
DOIs
Publication statusPublished - Aug 1 2015

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Glucose
Fasting
Population
Glucose Tolerance Test
Health Surveys
Hypoglycemic Agents
Biomarkers
Insulin
Gross Domestic Product
Sensitivity and Specificity
Surveys and Questionnaires
Regression Analysis
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis : A pooled analysis of 96 population-based studies with 331 288 participants. / Danaei, Goodarz; Fahimi, Saman; Lu, Yuan; Zhou, Bin; Hajifathalian, Kaveh; Cesare, Mariachiara Di; Lo, Wei Cheng; Reis-Santos, Barbara; Cowan, Melanie J.; Shaw, Jonathan E.; Bentham, James; Lin, John K.; Bixby, Honor; Magliano, Dianna; Bovet, Pascal; Miranda, J. Jaime; Khang, Young Ho; Stevens, Gretchen A.; Riley, Leanne M.; Ali, Mohammed K.; Ezzati, Majid; Kadir, Khalid Abdul; Abu-Rmeileh, Niveen M.; Acosta-Cazares, Benjamin; Aekplakorn, Wichai; Aguilar-Salinas, Carlos A.; Ahmadvand, Alireza; Nsour, Mohannad Al; Alkerwi, Ala'a; Amouyel, Philippe; Andersen, Lars Bo; Anderssen, Sigmund A.; Andrade, Dolores S.; Anjana, Ranjit Mohan; Aounallah-Skhiri, Hajer; Aris, Tahir; Arlappa, Nimmathota; Arveiler, Dominique; Assah, Felix K.; Avdicová, Mária; Balakrishna, Nagalla; Bandosz, Piotr; Barbagallo, Carlo M.; Alberto Barceló, Barceló; Batieha, Anwar M.; Baur, Louise A.; Romdhane, Habiba Ben; Bernabe-Ortiz, Antonio; Bhargava, Santosh K.; Bi, Yufang; Bjerregaard, Peter; Björkelund, Cecilia; Blake, Margaret; Blokstra, Anneke; Bo, Simona; Boehm, Bernhard O.; Boissonnet, Carlos P.; Brajkovich, Imperia; Breckenkamp, Juergen; Brewster, Lizzy M.; Brian, Garry R.; Bruno, Graziella; Bugge, Anna; de León, Antonio Cabrera; Can, Gunay; Cândido, Ana Paula C.; Capuano, Vincenzo; Carvalho, Maria J.; Casanueva, Felipe F.; Caserta, Carmelo A.; Castetbon, Katia; Chamukuttan, Snehalatha; Chaturvedi, Nishi; Chen, Chien Jen; Chen, Fangfang; Chen, Shuohua; Cheng, Ching Yu; Chetrit, Angela; Chiou, Shu Ti; Cho, Yumi; Chudek, Jerzy; Cifkova, Renata; Claessens, Frank; Concin, Hans; Cooper, Cyrus; Cooper, Rachel; Costanzo, Simona; Cottel, Dominique; Cowell, Chris; Crujeiras, Ana B.; D'Arrigo, Graziella; Dallongeville, Jean; Dankner, Rachel; Dauchet, Luc; de Gaetano, Giovanni; de Henauw, Stefaan; Deepa, Mohan; Dehghan, Abbas; Dhana, Klodian; Di Castelnuovo, Augusto F.; Djalalinia, Shirin; Doua, Kouamelan; Drygas, Wojciech; Du, Yong; Egbagbe, Eruke E.; Eggertsen, Robert; Ati, Jalila El; Elosua, Roberto; Erasmus, Rajiv T.; Erem, Cihangir; Ergor, Gul; Eriksen, Louise; Escobedo-de la Peña, Jorge; Fall, Caroline H.; Farzadfar, Farshad; Felix-Redondo, Francisco J.; Ferguson, Trevor S.; Fernández-Bergés, Daniel; Ferrari, Marika; Ferreccio, Catterina; Finn, Joseph D.; Föger, Bernhard; Foo, Leng Huat; Fouad, Heba M.; Francis, Damian K.; do Carmo Franco, Maria; Franco, Oscar H.; Frontera, Guillermo; Furusawa, Takuro; Gaciong, Zbigniew; Galbarczyk, Andrzej; Garnett, Sarah P.; Gaspoz, Jean Michel; Gasull, Magda; Gates, Louise; Geleijnse, Johanna M.; Ghasemain, Anoosheh; Giampaoli, Simona; Gianfagna, Francesco; Giovannelli, Jonathan; Gross, Marcela Gonzalez; González Rivas, Juan P.; Gorbea, Mariano Bonet; Gottrand, Frederic; Grant, Janet F.; Grodzicki, Tomasz; Grøntved, Anders; Gruden, Grabriella; Gu, Dongfeng; Guan, Ong Peng; Guerrero, Ramiro; Guessous, Idris; Guimaraes, Andre L.; Gutierrez, Laura; Hardy, Rebecca; Kumar, Rachakulla Hari; He, Jiang; Heidemann, Christin; Hihtaniemi, Ilpo Tapani; Ho, Sai Yin; Ho, Suzanne C.; Hofman, Albert; Russo Horimoto, Andrea R.V.; Hormiga, Claudia M.; Horta, Bernardo L.; Houti, Leila; Hussieni, Abdullatif S.; Huybrechts, Inge; Hwalla, Nahla; Iacoviello, Licia; Iannone, Anna G.; Ibrahim, Mohsen M.; Ikeda, Nayu; Ikram, Arfan M.; Irazola, Vilma E.; Islam, Muhammad; Iwasaki, Masanori; Jacobs, Jeremy M.; Jafar, Tazeen; Jasienska, Grazyna; Jiang, Chao Qiang; Jonas, Jost B.; Joshi, Pradeep; Kafatos, Anthony; Kalter-Leibovici, Ofra; Kasaeian, Amir; Katz, Joanne; Kaur, Prabhdeep; Kavousi, Maryam; Kelishadi, Roya; Kengne, Andre P.; Kersting, Mathilde; Khader, Yousef Saleh; Kiechl, Stefan; Kim, Jeongseon; Kiyohara, Yutaka; Kolsteren, Patrick; Korrovits, Paul; Koskinen, Seppo; Kratzer, Wolfgang; Kromhout, Daan; Kula, Krzysztof; Kurjata, Pawel; Kyobutungi, Catherine; Lachat, Carl; Laid, Youcef; Lam, Tai Hing; Landrove, Orlando; Lanska, Vera; Lappas, Georg; Laxmaiah, Avula; Leclercq, Catherine; Lee, Jeannette; Lee, Jeonghee; Lehtimäki, Terho; Rampal, Lekhraj; León-Muñoz, Luz M.; Li, Yanping; Lim, Wei Yen; Fernanda Lima-Costa, M.; Lin, Hsien Ho; Lin, Xu; Lissner, Lauren; Lorbeer, Roberto; Lozano, José Eugenio; Lundqvist, Annamari; Lytsy, Per; Ma, Guansheng; Machado-Coelho, George L.L.; Machi, Suka; Maggi, Stefania; Makdisse, Marcia; Rao, Kodavanti Mallikharjuna; Manios, Yannis; Manzato, Enzo; Margozzini, Paula; Marques-Vidal, Pedro; Martorell, Reynaldo; Masoodi, Shariq R.; Matsha, Tandi E.; Mbanya, Jean Claude N.; McFarlane, Shelly R.; McGarvey, Stephen T.; McLachlan, Stela; McNulty, Breige A.; Mediene-Benchekor, Sounnia; Meirhaeghe, Aline; Menezes, Ana Maria B.; Merat, Shahin; Meshram, Indrapal I.; Mi, Jie; Miquel, Juan Francisco; Mohamed, Mostafa K.; Mohammad, Kazem; Mohan, Viswanathan; Yusoff, Muhammad Fadhli Mohd; Moller, Niels C.; Molnar, Denes; Mondo, Charles K.; Moreno, Luis A.; Morgan, Karen; Moschonis, George; Mossakowska, Malgorzata; Mostafa, Aya; Mota, Jorge; Muiesan, Maria L.; Müller-Nurasyid, Martina; Mursu, Jaakko; Nagel, Gabriele; Namesna, Jana; Nang, Ei Ei K.; Nangia, Vinay B.; Navarrete-Muñoz, Eva Maria; Ndiaye, Ndeye Coumba; Nervi, Flavio; Nguyen, Nguyen D.; Nieto-Martínez, Ramfis E.; Ning, Guang; Ninomiya, Toshiharu; Noale, Marianna; Noto, Davide; Ochoa-Avilés, Angélica M.; Oh, Kyungwon; Onat, Altan; Osmond, Clive; Otero, Johanna A.; Palmieri, Luigi; Panda-Jonas, Songhomitra; Panza, Francesco; Parsaeian, Mahboubeh; Peixoto, Sergio Viana; Pereira, Alexandre C.; Peters, Annette; Peykari, Niloofar; Pilav, Aida; Pitakaka, Freda; Piwonska, Aleksandra; Piwonski, Jerzy; Plans-Rubió, Pedro; Porta, Miquel; Portegies, Marileen L.P.; Poustchi, Hossein; Pradeepa, Rajendra; Price, Jacqueline F.; Punab, Margus; Qasrawi, Radwan F.; Qorbani, Mostafa; Raitakari, Olli; Rao, Sudha Ramachandra; Ramachandran, Ambady; Ramos, Rafel; Rampal, Sanjay; Rathmann, Wolfgang; Redon, Josep; Reganit, Paul Ferdinand M.; Rigo, Fernando; Robinson, Sian M.; Robitaille, Cynthia; Rodríguez, Laura A.; Rodríguez-Artalejo, Fernando; Rodriguez-Perez, María del Cristo; Rojas-Martinez, Rosalba; Romaguera, Dora; Rosengren, Annika; Rubinstein, Adolfo; Rui, Ornelas; Ruiz-Betancourt, Blanca Sandra; Rutkowski, Marcin; Sabanayagam, Charumathi; Sachdev, Harshpal S.; Saidi, Olfa; Sakarya, Sibel; Salanave, Benoit; Salonen, Jukka T.; Salvetti, Massimo; Sánchez-Abanto, Jose; dos Santos, Renata Nunes; Santos, Rute; Sardinha, Luis B.; Scazufca, Marcia; Schargrodsky, Herman; Scheidt-Nave, Christa; Shibuya, Kenji; Shin, Youchan; Shiri, Rahman; Siantar, Rosalynn; Sibai, Abla M.; Simon, Mary; Simons, Judith; Simons, Leon A.; Sjostrom, Michael; Slowikowska-Hilczer, Jolanta; Slusarczyk, Przemyslaw; Smeeth, Liam; Snijder, Marieke B.; Solfrizzi, Vincenzo; Sonestedt, Emily; Soumare, Aicha; Staessen, Jan A.; Steene-Johannessen, Jostein; Stehle, Peter; Stein, Aryeh D.; Stessman, Jochanan; Stöckl, Doris; Stokwiszewski, Jakub; Strufaldi, Maria Wany; Sun, Chien An; Sundström, Johan; Suriyawongpaisal, Paibul; Sy, Rody G.; Tai, E. Shyong; Tarawneh, Mohammed; Tarqui-Mamani, Carolina B.; Thijs, Lutgarde; Tolstrup, Janne S.; Topbas, Murat; Torrent, Maties; Traissac, Pierre; Trinh, Oanh T.H.; Tulloch-Reid, Marshall K.; Tuomainen, Tomi Pekka; Turley, Maria L.; Tzourio, Christophe; Ueda, Peter; Ukoli, Flora M.; Ulmer, Hanno; Valdivia, Gonzalo; van Valkengoed, Irene G.M.; Vanderschueren, Dirk; Vanuzzo, Diego; Vega, Tomas; Velasquez-Melendez, Gustavo; Veronesi, Giovanni; Verschuren, Monique; Vioque, Jesus; Virtanen, Jyrki; Visvikis-Siest, Sophie; Viswanathan, Bharathi; Vollenweider, Peter; Voutilainen, Sari; Wade, Alisha N.; Wagner, Aline; Walton, Janette; Mohamud, Wan Nazaimoon Wan; Wang, Ming Dong; Wang, Ya Xing; Wannamethee, S. Goya; Weerasekera, Deepa; Whincup, Peter H.; Widhalm, Kurt; Wiecek, Andrzej; Wilks, Rainford J.; Willeit, Johann; Wojtyniak, Bogdan; Wong, Tien Yin; Woo, Jean; Woodward, Mark; Wu, Aleksander Giwercman; Wu, Frederick C.; Wu, Shou Ling; Xu, Haiquan; Yang, Xiaoguang; Ye, Xingwang; Yoshihara, Akihiro; Younger-Coleman, Novie O.; Zambon, Sabina; Zargar, Abdul Hamid; Zdrojewski, Tomasz; Zhao, Wenhua; Zheng, Yingfeng.

In: The Lancet Diabetes and Endocrinology, Vol. 3, No. 8, 01.08.2015, p. 624-637.

Research output: Contribution to journalArticle

Danaei, G, Fahimi, S, Lu, Y, Zhou, B, Hajifathalian, K, Cesare, MD, Lo, WC, Reis-Santos, B, Cowan, MJ, Shaw, JE, Bentham, J, Lin, JK, Bixby, H, Magliano, D, Bovet, P, Miranda, JJ, Khang, YH, Stevens, GA, Riley, LM, Ali, MK, Ezzati, M, Kadir, KA, Abu-Rmeileh, NM, Acosta-Cazares, B, Aekplakorn, W, Aguilar-Salinas, CA, Ahmadvand, A, Nsour, MA, Alkerwi, A, Amouyel, P, Andersen, LB, Anderssen, SA, Andrade, DS, Anjana, RM, Aounallah-Skhiri, H, Aris, T, Arlappa, N, Arveiler, D, Assah, FK, Avdicová, M, Balakrishna, N, Bandosz, P, Barbagallo, CM, Alberto Barceló, B, Batieha, AM, Baur, LA, Romdhane, HB, Bernabe-Ortiz, A, Bhargava, SK, Bi, Y, Bjerregaard, P, Björkelund, C, Blake, M, Blokstra, A, Bo, S, Boehm, BO, Boissonnet, CP, Brajkovich, I, Breckenkamp, J, Brewster, LM, Brian, GR, Bruno, G, Bugge, A, de León, AC, Can, G, Cândido, APC, Capuano, V, Carvalho, MJ, Casanueva, FF, Caserta, CA, Castetbon, K, Chamukuttan, S, Chaturvedi, N, Chen, CJ, Chen, F, Chen, S, Cheng, CY, Chetrit, A, Chiou, ST, Cho, Y, Chudek, J, Cifkova, R, Claessens, F, Concin, H, Cooper, C, Cooper, R, Costanzo, S, Cottel, D, Cowell, C, Crujeiras, AB, D'Arrigo, G, Dallongeville, J, Dankner, R, Dauchet, L, de Gaetano, G, de Henauw, S, Deepa, M, Dehghan, A, Dhana, K, Di Castelnuovo, AF, Djalalinia, S, Doua, K, Drygas, W, Du, Y, Egbagbe, EE, Eggertsen, R, Ati, JE, Elosua, R, Erasmus, RT, Erem, C, Ergor, G, Eriksen, L, Escobedo-de la Peña, J, Fall, CH, Farzadfar, F, Felix-Redondo, FJ, Ferguson, TS, Fernández-Bergés, D, Ferrari, M, Ferreccio, C, Finn, JD, Föger, B, Foo, LH, Fouad, HM, Francis, DK, do Carmo Franco, M, Franco, OH, Frontera, G, Furusawa, T, Gaciong, Z, Galbarczyk, A, Garnett, SP, Gaspoz, JM, Gasull, M, Gates, L, Geleijnse, JM, Ghasemain, A, Giampaoli, S, Gianfagna, F, Giovannelli, J, Gross, MG, González Rivas, JP, Gorbea, MB, Gottrand, F, Grant, JF, Grodzicki, T, Grøntved, A, Gruden, G, Gu, D, Guan, OP, Guerrero, R, Guessous, I, Guimaraes, AL, Gutierrez, L, Hardy, R, Kumar, RH, He, J, Heidemann, C, Hihtaniemi, IT, Ho, SY, Ho, SC, Hofman, A, Russo Horimoto, ARV, Hormiga, CM, Horta, BL, Houti, L, Hussieni, AS, Huybrechts, I, Hwalla, N, Iacoviello, L, Iannone, AG, Ibrahim, MM, Ikeda, N, Ikram, AM, Irazola, VE, Islam, M, Iwasaki, M, Jacobs, JM, Jafar, T, Jasienska, G, Jiang, CQ, Jonas, JB, Joshi, P, Kafatos, A, Kalter-Leibovici, O, Kasaeian, A, Katz, J, Kaur, P, Kavousi, M, Kelishadi, R, Kengne, AP, Kersting, M, Khader, YS, Kiechl, S, Kim, J, Kiyohara, Y, Kolsteren, P, Korrovits, P, Koskinen, S, Kratzer, W, Kromhout, D, Kula, K, Kurjata, P, Kyobutungi, C, Lachat, C, Laid, Y, Lam, TH, Landrove, O, Lanska, V, Lappas, G, Laxmaiah, A, Leclercq, C, Lee, J, Lee, J, Lehtimäki, T, Rampal, L, León-Muñoz, LM, Li, Y, Lim, WY, Fernanda Lima-Costa, M, Lin, HH, Lin, X, Lissner, L, Lorbeer, R, Lozano, JE, Lundqvist, A, Lytsy, P, Ma, G, Machado-Coelho, GLL, Machi, S, Maggi, S, Makdisse, M, Rao, KM, Manios, Y, Manzato, E, Margozzini, P, Marques-Vidal, P, Martorell, R, Masoodi, SR, Matsha, TE, Mbanya, JCN, McFarlane, SR, McGarvey, ST, McLachlan, S, McNulty, BA, Mediene-Benchekor, S, Meirhaeghe, A, Menezes, AMB, Merat, S, Meshram, II, Mi, J, Miquel, JF, Mohamed, MK, Mohammad, K, Mohan, V, Yusoff, MFM, Moller, NC, Molnar, D, Mondo, CK, Moreno, LA, Morgan, K, Moschonis, G, Mossakowska, M, Mostafa, A, Mota, J, Muiesan, ML, Müller-Nurasyid, M, Mursu, J, Nagel, G, Namesna, J, Nang, EEK, Nangia, VB, Navarrete-Muñoz, EM, Ndiaye, NC, Nervi, F, Nguyen, ND, Nieto-Martínez, RE, Ning, G, Ninomiya, T, Noale, M, Noto, D, Ochoa-Avilés, AM, Oh, K, Onat, A, Osmond, C, Otero, JA, Palmieri, L, Panda-Jonas, S, Panza, F, Parsaeian, M, Peixoto, SV, Pereira, AC, Peters, A, Peykari, N, Pilav, A, Pitakaka, F, Piwonska, A, Piwonski, J, Plans-Rubió, P, Porta, M, Portegies, MLP, Poustchi, H, Pradeepa, R, Price, JF, Punab, M, Qasrawi, RF, Qorbani, M, Raitakari, O, Rao, SR, Ramachandran, A, Ramos, R, Rampal, S, Rathmann, W, Redon, J, Reganit, PFM, Rigo, F, Robinson, SM, Robitaille, C, Rodríguez, LA, Rodríguez-Artalejo, F, Rodriguez-Perez, MDC, Rojas-Martinez, R, Romaguera, D, Rosengren, A, Rubinstein, A, Rui, O, Ruiz-Betancourt, BS, Rutkowski, M, Sabanayagam, C, Sachdev, HS, Saidi, O, Sakarya, S, Salanave, B, Salonen, JT, Salvetti, M, Sánchez-Abanto, J, dos Santos, RN, Santos, R, Sardinha, LB, Scazufca, M, Schargrodsky, H, Scheidt-Nave, C, Shibuya, K, Shin, Y, Shiri, R, Siantar, R, Sibai, AM, Simon, M, Simons, J, Simons, LA, Sjostrom, M, Slowikowska-Hilczer, J, Slusarczyk, P, Smeeth, L, Snijder, MB, Solfrizzi, V, Sonestedt, E, Soumare, A, Staessen, JA, Steene-Johannessen, J, Stehle, P, Stein, AD, Stessman, J, Stöckl, D, Stokwiszewski, J, Strufaldi, MW, Sun, CA, Sundström, J, Suriyawongpaisal, P, Sy, RG, Tai, ES, Tarawneh, M, Tarqui-Mamani, CB, Thijs, L, Tolstrup, JS, Topbas, M, Torrent, M, Traissac, P, Trinh, OTH, Tulloch-Reid, MK, Tuomainen, TP, Turley, ML, Tzourio, C, Ueda, P, Ukoli, FM, Ulmer, H, Valdivia, G, van Valkengoed, IGM, Vanderschueren, D, Vanuzzo, D, Vega, T, Velasquez-Melendez, G, Veronesi, G, Verschuren, M, Vioque, J, Virtanen, J, Visvikis-Siest, S, Viswanathan, B, Vollenweider, P, Voutilainen, S, Wade, AN, Wagner, A, Walton, J, Mohamud, WNW, Wang, MD, Wang, YX, Wannamethee, SG, Weerasekera, D, Whincup, PH, Widhalm, K, Wiecek, A, Wilks, RJ, Willeit, J, Wojtyniak, B, Wong, TY, Woo, J, Woodward, M, Wu, AG, Wu, FC, Wu, SL, Xu, H, Yang, X, Ye, X, Yoshihara, A, Younger-Coleman, NO, Zambon, S, Zargar, AH, Zdrojewski, T, Zhao, W & Zheng, Y 2015, 'Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants', The Lancet Diabetes and Endocrinology, vol. 3, no. 8, pp. 624-637. https://doi.org/10.1016/S2213-8587(15)00129-1
Danaei, Goodarz ; Fahimi, Saman ; Lu, Yuan ; Zhou, Bin ; Hajifathalian, Kaveh ; Cesare, Mariachiara Di ; Lo, Wei Cheng ; Reis-Santos, Barbara ; Cowan, Melanie J. ; Shaw, Jonathan E. ; Bentham, James ; Lin, John K. ; Bixby, Honor ; Magliano, Dianna ; Bovet, Pascal ; Miranda, J. Jaime ; Khang, Young Ho ; Stevens, Gretchen A. ; Riley, Leanne M. ; Ali, Mohammed K. ; Ezzati, Majid ; Kadir, Khalid Abdul ; Abu-Rmeileh, Niveen M. ; Acosta-Cazares, Benjamin ; Aekplakorn, Wichai ; Aguilar-Salinas, Carlos A. ; Ahmadvand, Alireza ; Nsour, Mohannad Al ; Alkerwi, Ala'a ; Amouyel, Philippe ; Andersen, Lars Bo ; Anderssen, Sigmund A. ; Andrade, Dolores S. ; Anjana, Ranjit Mohan ; Aounallah-Skhiri, Hajer ; Aris, Tahir ; Arlappa, Nimmathota ; Arveiler, Dominique ; Assah, Felix K. ; Avdicová, Mária ; Balakrishna, Nagalla ; Bandosz, Piotr ; Barbagallo, Carlo M. ; Alberto Barceló, Barceló ; Batieha, Anwar M. ; Baur, Louise A. ; Romdhane, Habiba Ben ; Bernabe-Ortiz, Antonio ; Bhargava, Santosh K. ; Bi, Yufang ; Bjerregaard, Peter ; Björkelund, Cecilia ; Blake, Margaret ; Blokstra, Anneke ; Bo, Simona ; Boehm, Bernhard O. ; Boissonnet, Carlos P. ; Brajkovich, Imperia ; Breckenkamp, Juergen ; Brewster, Lizzy M. ; Brian, Garry R. ; Bruno, Graziella ; Bugge, Anna ; de León, Antonio Cabrera ; Can, Gunay ; Cândido, Ana Paula C. ; Capuano, Vincenzo ; Carvalho, Maria J. ; Casanueva, Felipe F. ; Caserta, Carmelo A. ; Castetbon, Katia ; Chamukuttan, Snehalatha ; Chaturvedi, Nishi ; Chen, Chien Jen ; Chen, Fangfang ; Chen, Shuohua ; Cheng, Ching Yu ; Chetrit, Angela ; Chiou, Shu Ti ; Cho, Yumi ; Chudek, Jerzy ; Cifkova, Renata ; Claessens, Frank ; Concin, Hans ; Cooper, Cyrus ; Cooper, Rachel ; Costanzo, Simona ; Cottel, Dominique ; Cowell, Chris ; Crujeiras, Ana B. ; D'Arrigo, Graziella ; Dallongeville, Jean ; Dankner, Rachel ; Dauchet, Luc ; de Gaetano, Giovanni ; de Henauw, Stefaan ; Deepa, Mohan ; Dehghan, Abbas ; Dhana, Klodian ; Di Castelnuovo, Augusto F. ; Djalalinia, Shirin ; Doua, Kouamelan ; Drygas, Wojciech ; Du, Yong ; Egbagbe, Eruke E. ; Eggertsen, Robert ; Ati, Jalila El ; Elosua, Roberto ; Erasmus, Rajiv T. ; Erem, Cihangir ; Ergor, Gul ; Eriksen, Louise ; Escobedo-de la Peña, Jorge ; Fall, Caroline H. ; Farzadfar, Farshad ; Felix-Redondo, Francisco J. ; Ferguson, Trevor S. ; Fernández-Bergés, Daniel ; Ferrari, Marika ; Ferreccio, Catterina ; Finn, Joseph D. ; Föger, Bernhard ; Foo, Leng Huat ; Fouad, Heba M. ; Francis, Damian K. ; do Carmo Franco, Maria ; Franco, Oscar H. ; Frontera, Guillermo ; Furusawa, Takuro ; Gaciong, Zbigniew ; Galbarczyk, Andrzej ; Garnett, Sarah P. ; Gaspoz, Jean Michel ; Gasull, Magda ; Gates, Louise ; Geleijnse, Johanna M. ; Ghasemain, Anoosheh ; Giampaoli, Simona ; Gianfagna, Francesco ; Giovannelli, Jonathan ; Gross, Marcela Gonzalez ; González Rivas, Juan P. ; Gorbea, Mariano Bonet ; Gottrand, Frederic ; Grant, Janet F. ; Grodzicki, Tomasz ; Grøntved, Anders ; Gruden, Grabriella ; Gu, Dongfeng ; Guan, Ong Peng ; Guerrero, Ramiro ; Guessous, Idris ; Guimaraes, Andre L. ; Gutierrez, Laura ; Hardy, Rebecca ; Kumar, Rachakulla Hari ; He, Jiang ; Heidemann, Christin ; Hihtaniemi, Ilpo Tapani ; Ho, Sai Yin ; Ho, Suzanne C. ; Hofman, Albert ; Russo Horimoto, Andrea R.V. ; Hormiga, Claudia M. ; Horta, Bernardo L. ; Houti, Leila ; Hussieni, Abdullatif S. ; Huybrechts, Inge ; Hwalla, Nahla ; Iacoviello, Licia ; Iannone, Anna G. ; Ibrahim, Mohsen M. ; Ikeda, Nayu ; Ikram, Arfan M. ; Irazola, Vilma E. ; Islam, Muhammad ; Iwasaki, Masanori ; Jacobs, Jeremy M. ; Jafar, Tazeen ; Jasienska, Grazyna ; Jiang, Chao Qiang ; Jonas, Jost B. ; Joshi, Pradeep ; Kafatos, Anthony ; Kalter-Leibovici, Ofra ; Kasaeian, Amir ; Katz, Joanne ; Kaur, Prabhdeep ; Kavousi, Maryam ; Kelishadi, Roya ; Kengne, Andre P. ; Kersting, Mathilde ; Khader, Yousef Saleh ; Kiechl, Stefan ; Kim, Jeongseon ; Kiyohara, Yutaka ; Kolsteren, Patrick ; Korrovits, Paul ; Koskinen, Seppo ; Kratzer, Wolfgang ; Kromhout, Daan ; Kula, Krzysztof ; Kurjata, Pawel ; Kyobutungi, Catherine ; Lachat, Carl ; Laid, Youcef ; Lam, Tai Hing ; Landrove, Orlando ; Lanska, Vera ; Lappas, Georg ; Laxmaiah, Avula ; Leclercq, Catherine ; Lee, Jeannette ; Lee, Jeonghee ; Lehtimäki, Terho ; Rampal, Lekhraj ; León-Muñoz, Luz M. ; Li, Yanping ; Lim, Wei Yen ; Fernanda Lima-Costa, M. ; Lin, Hsien Ho ; Lin, Xu ; Lissner, Lauren ; Lorbeer, Roberto ; Lozano, José Eugenio ; Lundqvist, Annamari ; Lytsy, Per ; Ma, Guansheng ; Machado-Coelho, George L.L. ; Machi, Suka ; Maggi, Stefania ; Makdisse, Marcia ; Rao, Kodavanti Mallikharjuna ; Manios, Yannis ; Manzato, Enzo ; Margozzini, Paula ; Marques-Vidal, Pedro ; Martorell, Reynaldo ; Masoodi, Shariq R. ; Matsha, Tandi E. ; Mbanya, Jean Claude N. ; McFarlane, Shelly R. ; McGarvey, Stephen T. ; McLachlan, Stela ; McNulty, Breige A. ; Mediene-Benchekor, Sounnia ; Meirhaeghe, Aline ; Menezes, Ana Maria B. ; Merat, Shahin ; Meshram, Indrapal I. ; Mi, Jie ; Miquel, Juan Francisco ; Mohamed, Mostafa K. ; Mohammad, Kazem ; Mohan, Viswanathan ; Yusoff, Muhammad Fadhli Mohd ; Moller, Niels C. ; Molnar, Denes ; Mondo, Charles K. ; Moreno, Luis A. ; Morgan, Karen ; Moschonis, George ; Mossakowska, Malgorzata ; Mostafa, Aya ; Mota, Jorge ; Muiesan, Maria L. ; Müller-Nurasyid, Martina ; Mursu, Jaakko ; Nagel, Gabriele ; Namesna, Jana ; Nang, Ei Ei K. ; Nangia, Vinay B. ; Navarrete-Muñoz, Eva Maria ; Ndiaye, Ndeye Coumba ; Nervi, Flavio ; Nguyen, Nguyen D. ; Nieto-Martínez, Ramfis E. ; Ning, Guang ; Ninomiya, Toshiharu ; Noale, Marianna ; Noto, Davide ; Ochoa-Avilés, Angélica M. ; Oh, Kyungwon ; Onat, Altan ; Osmond, Clive ; Otero, Johanna A. ; Palmieri, Luigi ; Panda-Jonas, Songhomitra ; Panza, Francesco ; Parsaeian, Mahboubeh ; Peixoto, Sergio Viana ; Pereira, Alexandre C. ; Peters, Annette ; Peykari, Niloofar ; Pilav, Aida ; Pitakaka, Freda ; Piwonska, Aleksandra ; Piwonski, Jerzy ; Plans-Rubió, Pedro ; Porta, Miquel ; Portegies, Marileen L.P. ; Poustchi, Hossein ; Pradeepa, Rajendra ; Price, Jacqueline F. ; Punab, Margus ; Qasrawi, Radwan F. ; Qorbani, Mostafa ; Raitakari, Olli ; Rao, Sudha Ramachandra ; Ramachandran, Ambady ; Ramos, Rafel ; Rampal, Sanjay ; Rathmann, Wolfgang ; Redon, Josep ; Reganit, Paul Ferdinand M. ; Rigo, Fernando ; Robinson, Sian M. ; Robitaille, Cynthia ; Rodríguez, Laura A. ; Rodríguez-Artalejo, Fernando ; Rodriguez-Perez, María del Cristo ; Rojas-Martinez, Rosalba ; Romaguera, Dora ; Rosengren, Annika ; Rubinstein, Adolfo ; Rui, Ornelas ; Ruiz-Betancourt, Blanca Sandra ; Rutkowski, Marcin ; Sabanayagam, Charumathi ; Sachdev, Harshpal S. ; Saidi, Olfa ; Sakarya, Sibel ; Salanave, Benoit ; Salonen, Jukka T. ; Salvetti, Massimo ; Sánchez-Abanto, Jose ; dos Santos, Renata Nunes ; Santos, Rute ; Sardinha, Luis B. ; Scazufca, Marcia ; Schargrodsky, Herman ; Scheidt-Nave, Christa ; Shibuya, Kenji ; Shin, Youchan ; Shiri, Rahman ; Siantar, Rosalynn ; Sibai, Abla M. ; Simon, Mary ; Simons, Judith ; Simons, Leon A. ; Sjostrom, Michael ; Slowikowska-Hilczer, Jolanta ; Slusarczyk, Przemyslaw ; Smeeth, Liam ; Snijder, Marieke B. ; Solfrizzi, Vincenzo ; Sonestedt, Emily ; Soumare, Aicha ; Staessen, Jan A. ; Steene-Johannessen, Jostein ; Stehle, Peter ; Stein, Aryeh D. ; Stessman, Jochanan ; Stöckl, Doris ; Stokwiszewski, Jakub ; Strufaldi, Maria Wany ; Sun, Chien An ; Sundström, Johan ; Suriyawongpaisal, Paibul ; Sy, Rody G. ; Tai, E. Shyong ; Tarawneh, Mohammed ; Tarqui-Mamani, Carolina B. ; Thijs, Lutgarde ; Tolstrup, Janne S. ; Topbas, Murat ; Torrent, Maties ; Traissac, Pierre ; Trinh, Oanh T.H. ; Tulloch-Reid, Marshall K. ; Tuomainen, Tomi Pekka ; Turley, Maria L. ; Tzourio, Christophe ; Ueda, Peter ; Ukoli, Flora M. ; Ulmer, Hanno ; Valdivia, Gonzalo ; van Valkengoed, Irene G.M. ; Vanderschueren, Dirk ; Vanuzzo, Diego ; Vega, Tomas ; Velasquez-Melendez, Gustavo ; Veronesi, Giovanni ; Verschuren, Monique ; Vioque, Jesus ; Virtanen, Jyrki ; Visvikis-Siest, Sophie ; Viswanathan, Bharathi ; Vollenweider, Peter ; Voutilainen, Sari ; Wade, Alisha N. ; Wagner, Aline ; Walton, Janette ; Mohamud, Wan Nazaimoon Wan ; Wang, Ming Dong ; Wang, Ya Xing ; Wannamethee, S. Goya ; Weerasekera, Deepa ; Whincup, Peter H. ; Widhalm, Kurt ; Wiecek, Andrzej ; Wilks, Rainford J. ; Willeit, Johann ; Wojtyniak, Bogdan ; Wong, Tien Yin ; Woo, Jean ; Woodward, Mark ; Wu, Aleksander Giwercman ; Wu, Frederick C. ; Wu, Shou Ling ; Xu, Haiquan ; Yang, Xiaoguang ; Ye, Xingwang ; Yoshihara, Akihiro ; Younger-Coleman, Novie O. ; Zambon, Sabina ; Zargar, Abdul Hamid ; Zdrojewski, Tomasz ; Zhao, Wenhua ; Zheng, Yingfeng. / Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis : A pooled analysis of 96 population-based studies with 331 288 participants. In: The Lancet Diabetes and Endocrinology. 2015 ; Vol. 3, No. 8. pp. 624-637.
@article{e5d58329c8e74036b999fef8ce0f6d41,
title = "Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants",
abstract = "Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5{\%} or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8{\%} of age-sex-survey groups and higher in another 41·6{\%}; in the other 15·6{\%}, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5{\%} or more had a pooled sensitivity of 52·8{\%} (95{\%} CI 51·3-54·3{\%}) and a pooled specificity of 99·74{\%} (99·71-99·78{\%}) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5{\%} (28·7-32·3{\%}). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.",
author = "Goodarz Danaei and Saman Fahimi and Yuan Lu and Bin Zhou and Kaveh Hajifathalian and Cesare, {Mariachiara Di} and Lo, {Wei Cheng} and Barbara Reis-Santos and Cowan, {Melanie J.} and Shaw, {Jonathan E.} and James Bentham and Lin, {John K.} and Honor Bixby and Dianna Magliano and Pascal Bovet and Miranda, {J. Jaime} and Khang, {Young Ho} and Stevens, {Gretchen A.} and Riley, {Leanne M.} and Ali, {Mohammed K.} and Majid Ezzati and Kadir, {Khalid Abdul} and Abu-Rmeileh, {Niveen M.} and Benjamin Acosta-Cazares and Wichai Aekplakorn and Aguilar-Salinas, {Carlos A.} and Alireza Ahmadvand and Nsour, {Mohannad Al} and Ala'a Alkerwi and Philippe Amouyel and Andersen, {Lars Bo} and Anderssen, {Sigmund A.} and Andrade, {Dolores S.} and Anjana, {Ranjit Mohan} and Hajer Aounallah-Skhiri and Tahir Aris and Nimmathota Arlappa and Dominique Arveiler and Assah, {Felix K.} and M{\'a}ria Avdicov{\'a} and Nagalla Balakrishna and Piotr Bandosz and Barbagallo, {Carlo M.} and {Alberto Barcel{\'o}}, Barcel{\'o} and Batieha, {Anwar M.} and Baur, {Louise A.} and Romdhane, {Habiba Ben} and Antonio Bernabe-Ortiz and Bhargava, {Santosh K.} and Yufang Bi and Peter Bjerregaard and Cecilia Bj{\"o}rkelund and Margaret Blake and Anneke Blokstra and Simona Bo and Boehm, {Bernhard O.} and Boissonnet, {Carlos P.} and Imperia Brajkovich and Juergen Breckenkamp and Brewster, {Lizzy M.} and Brian, {Garry R.} and Graziella Bruno and Anna Bugge and {de Le{\'o}n}, {Antonio Cabrera} and Gunay Can and C{\^a}ndido, {Ana Paula C.} and Vincenzo Capuano and Carvalho, {Maria J.} and Casanueva, {Felipe F.} and Caserta, {Carmelo A.} and Katia Castetbon and Snehalatha Chamukuttan and Nishi Chaturvedi and Chen, {Chien Jen} and Fangfang Chen and Shuohua Chen and Cheng, {Ching Yu} and Angela Chetrit and Chiou, {Shu Ti} and Yumi Cho and Jerzy Chudek and Renata Cifkova and Frank Claessens and Hans Concin and Cyrus Cooper and Rachel Cooper and Simona Costanzo and Dominique Cottel and Chris Cowell and Crujeiras, {Ana B.} and Graziella D'Arrigo and Jean Dallongeville and Rachel Dankner and Luc Dauchet and {de Gaetano}, Giovanni and {de Henauw}, Stefaan and Mohan Deepa and Abbas Dehghan and Klodian Dhana and {Di Castelnuovo}, {Augusto F.} and Shirin Djalalinia and Kouamelan Doua and Wojciech Drygas and Yong Du and Egbagbe, {Eruke E.} and Robert Eggertsen and Ati, {Jalila El} and Roberto Elosua and Erasmus, {Rajiv T.} and Cihangir Erem and Gul Ergor and Louise Eriksen and {Escobedo-de la Pe{\~n}a}, Jorge and Fall, {Caroline H.} and Farshad Farzadfar and Felix-Redondo, {Francisco J.} and Ferguson, {Trevor S.} and Daniel Fern{\'a}ndez-Berg{\'e}s and Marika Ferrari and Catterina Ferreccio and Finn, {Joseph D.} and Bernhard F{\"o}ger and Foo, {Leng Huat} and Fouad, {Heba M.} and Francis, {Damian K.} and {do Carmo Franco}, Maria and Franco, {Oscar H.} and Guillermo Frontera and Takuro Furusawa and Zbigniew Gaciong and Andrzej Galbarczyk and Garnett, {Sarah P.} and Gaspoz, {Jean Michel} and Magda Gasull and Louise Gates and Geleijnse, {Johanna M.} and Anoosheh Ghasemain and Simona Giampaoli and Francesco Gianfagna and Jonathan Giovannelli and Gross, {Marcela Gonzalez} and {Gonz{\'a}lez Rivas}, {Juan P.} and Gorbea, {Mariano Bonet} and Frederic Gottrand and Grant, {Janet F.} and Tomasz Grodzicki and Anders Gr{\o}ntved and Grabriella Gruden and Dongfeng Gu and Guan, {Ong Peng} and Ramiro Guerrero and Idris Guessous and Guimaraes, {Andre L.} and Laura Gutierrez and Rebecca Hardy and Kumar, {Rachakulla Hari} and Jiang He and Christin Heidemann and Hihtaniemi, {Ilpo Tapani} and Ho, {Sai Yin} and Ho, {Suzanne C.} and Albert Hofman and {Russo Horimoto}, {Andrea R.V.} and Hormiga, {Claudia M.} and Horta, {Bernardo L.} and Leila Houti and Hussieni, {Abdullatif S.} and Inge Huybrechts and Nahla Hwalla and Licia Iacoviello and Iannone, {Anna G.} and Ibrahim, {Mohsen M.} and Nayu Ikeda and Ikram, {Arfan M.} and Irazola, {Vilma E.} and Muhammad Islam and Masanori Iwasaki and Jacobs, {Jeremy M.} and Tazeen Jafar and Grazyna Jasienska and Jiang, {Chao Qiang} and Jonas, {Jost B.} and Pradeep Joshi and Anthony Kafatos and Ofra Kalter-Leibovici and Amir Kasaeian and Joanne Katz and Prabhdeep Kaur and Maryam Kavousi and Roya Kelishadi and Kengne, {Andre P.} and Mathilde Kersting and Khader, {Yousef Saleh} and Stefan Kiechl and Jeongseon Kim and Yutaka Kiyohara and Patrick Kolsteren and Paul Korrovits and Seppo Koskinen and Wolfgang Kratzer and Daan Kromhout and Krzysztof Kula and Pawel Kurjata and Catherine Kyobutungi and Carl Lachat and Youcef Laid and Lam, {Tai Hing} and Orlando Landrove and Vera Lanska and Georg Lappas and Avula Laxmaiah and Catherine Leclercq and Jeannette Lee and Jeonghee Lee and Terho Lehtim{\"a}ki and Lekhraj Rampal and Le{\'o}n-Mu{\~n}oz, {Luz M.} and Yanping Li and Lim, {Wei Yen} and {Fernanda Lima-Costa}, M. and Lin, {Hsien Ho} and Xu Lin and Lauren Lissner and Roberto Lorbeer and Lozano, {Jos{\'e} Eugenio} and Annamari Lundqvist and Per Lytsy and Guansheng Ma and Machado-Coelho, {George L.L.} and Suka Machi and Stefania Maggi and Marcia Makdisse and Rao, {Kodavanti Mallikharjuna} and Yannis Manios and Enzo Manzato and Paula Margozzini and Pedro Marques-Vidal and Reynaldo Martorell and Masoodi, {Shariq R.} and Matsha, {Tandi E.} and Mbanya, {Jean Claude N.} and McFarlane, {Shelly R.} and McGarvey, {Stephen T.} and Stela McLachlan and McNulty, {Breige A.} and Sounnia Mediene-Benchekor and Aline Meirhaeghe and Menezes, {Ana Maria B.} and Shahin Merat and Meshram, {Indrapal I.} and Jie Mi and Miquel, {Juan Francisco} and Mohamed, {Mostafa K.} and Kazem Mohammad and Viswanathan Mohan and Yusoff, {Muhammad Fadhli Mohd} and Moller, {Niels C.} and Denes Molnar and Mondo, {Charles K.} and Moreno, {Luis A.} and Karen Morgan and George Moschonis and Malgorzata Mossakowska and Aya Mostafa and Jorge Mota and Muiesan, {Maria L.} and Martina M{\"u}ller-Nurasyid and Jaakko Mursu and Gabriele Nagel and Jana Namesna and Nang, {Ei Ei K.} and Nangia, {Vinay B.} and Navarrete-Mu{\~n}oz, {Eva Maria} and Ndiaye, {Ndeye Coumba} and Flavio Nervi and Nguyen, {Nguyen D.} and Nieto-Mart{\'i}nez, {Ramfis E.} and Guang Ning and Toshiharu Ninomiya and Marianna Noale and Davide Noto and Ochoa-Avil{\'e}s, {Ang{\'e}lica M.} and Kyungwon Oh and Altan Onat and Clive Osmond and Otero, {Johanna A.} and Luigi Palmieri and Songhomitra Panda-Jonas and Francesco Panza and Mahboubeh Parsaeian and Peixoto, {Sergio Viana} and Pereira, {Alexandre C.} and Annette Peters and Niloofar Peykari and Aida Pilav and Freda Pitakaka and Aleksandra Piwonska and Jerzy Piwonski and Pedro Plans-Rubi{\'o} and Miquel Porta and Portegies, {Marileen L.P.} and Hossein Poustchi and Rajendra Pradeepa and Price, {Jacqueline F.} and Margus Punab and Qasrawi, {Radwan F.} and Mostafa Qorbani and Olli Raitakari and Rao, {Sudha Ramachandra} and Ambady Ramachandran and Rafel Ramos and Sanjay Rampal and Wolfgang Rathmann and Josep Redon and Reganit, {Paul Ferdinand M.} and Fernando Rigo and Robinson, {Sian M.} and Cynthia Robitaille and Rodr{\'i}guez, {Laura A.} and Fernando Rodr{\'i}guez-Artalejo and Rodriguez-Perez, {Mar{\'i}a del Cristo} and Rosalba Rojas-Martinez and Dora Romaguera and Annika Rosengren and Adolfo Rubinstein and Ornelas Rui and Ruiz-Betancourt, {Blanca Sandra} and Marcin Rutkowski and Charumathi Sabanayagam and Sachdev, {Harshpal S.} and Olfa Saidi and Sibel Sakarya and Benoit Salanave and Salonen, {Jukka T.} and Massimo Salvetti and Jose S{\'a}nchez-Abanto and {dos Santos}, {Renata Nunes} and Rute Santos and Sardinha, {Luis B.} and Marcia Scazufca and Herman Schargrodsky and Christa Scheidt-Nave and Kenji Shibuya and Youchan Shin and Rahman Shiri and Rosalynn Siantar and Sibai, {Abla M.} and Mary Simon and Judith Simons and Simons, {Leon A.} and Michael Sjostrom and Jolanta Slowikowska-Hilczer and Przemyslaw Slusarczyk and Liam Smeeth and Snijder, {Marieke B.} and Vincenzo Solfrizzi and Emily Sonestedt and Aicha Soumare and Staessen, {Jan A.} and Jostein Steene-Johannessen and Peter Stehle and Stein, {Aryeh D.} and Jochanan Stessman and Doris St{\"o}ckl and Jakub Stokwiszewski and Strufaldi, {Maria Wany} and Sun, {Chien An} and Johan Sundstr{\"o}m and Paibul Suriyawongpaisal and Sy, {Rody G.} and Tai, {E. Shyong} and Mohammed Tarawneh and Tarqui-Mamani, {Carolina B.} and Lutgarde Thijs and Tolstrup, {Janne S.} and Murat Topbas and Maties Torrent and Pierre Traissac and Trinh, {Oanh T.H.} and Tulloch-Reid, {Marshall K.} and Tuomainen, {Tomi Pekka} and Turley, {Maria L.} and Christophe Tzourio and Peter Ueda and Ukoli, {Flora M.} and Hanno Ulmer and Gonzalo Valdivia and {van Valkengoed}, {Irene G.M.} and Dirk Vanderschueren and Diego Vanuzzo and Tomas Vega and Gustavo Velasquez-Melendez and Giovanni Veronesi and Monique Verschuren and Jesus Vioque and Jyrki Virtanen and Sophie Visvikis-Siest and Bharathi Viswanathan and Peter Vollenweider and Sari Voutilainen and Wade, {Alisha N.} and Aline Wagner and Janette Walton and Mohamud, {Wan Nazaimoon Wan} and Wang, {Ming Dong} and Wang, {Ya Xing} and Wannamethee, {S. Goya} and Deepa Weerasekera and Whincup, {Peter H.} and Kurt Widhalm and Andrzej Wiecek and Wilks, {Rainford J.} and Johann Willeit and Bogdan Wojtyniak and Wong, {Tien Yin} and Jean Woo and Mark Woodward and Wu, {Aleksander Giwercman} and Wu, {Frederick C.} and Wu, {Shou Ling} and Haiquan Xu and Xiaoguang Yang and Xingwang Ye and Akihiro Yoshihara and Younger-Coleman, {Novie O.} and Sabina Zambon and Zargar, {Abdul Hamid} and Tomasz Zdrojewski and Wenhua Zhao and Yingfeng Zheng",
year = "2015",
month = "8",
day = "1",
doi = "10.1016/S2213-8587(15)00129-1",
language = "English",
volume = "3",
pages = "624--637",
journal = "The Lancet Diabetes and Endocrinology",
issn = "2213-8587",
publisher = "Elsevier BV",
number = "8",

}

TY - JOUR

T1 - Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis

T2 - A pooled analysis of 96 population-based studies with 331 288 participants

AU - Danaei, Goodarz

AU - Fahimi, Saman

AU - Lu, Yuan

AU - Zhou, Bin

AU - Hajifathalian, Kaveh

AU - Cesare, Mariachiara Di

AU - Lo, Wei Cheng

AU - Reis-Santos, Barbara

AU - Cowan, Melanie J.

AU - Shaw, Jonathan E.

AU - Bentham, James

AU - Lin, John K.

AU - Bixby, Honor

AU - Magliano, Dianna

AU - Bovet, Pascal

AU - Miranda, J. Jaime

AU - Khang, Young Ho

AU - Stevens, Gretchen A.

AU - Riley, Leanne M.

AU - Ali, Mohammed K.

AU - Ezzati, Majid

AU - Kadir, Khalid Abdul

AU - Abu-Rmeileh, Niveen M.

AU - Acosta-Cazares, Benjamin

AU - Aekplakorn, Wichai

AU - Aguilar-Salinas, Carlos A.

AU - Ahmadvand, Alireza

AU - Nsour, Mohannad Al

AU - Alkerwi, Ala'a

AU - Amouyel, Philippe

AU - Andersen, Lars Bo

AU - Anderssen, Sigmund A.

AU - Andrade, Dolores S.

AU - Anjana, Ranjit Mohan

AU - Aounallah-Skhiri, Hajer

AU - Aris, Tahir

AU - Arlappa, Nimmathota

AU - Arveiler, Dominique

AU - Assah, Felix K.

AU - Avdicová, Mária

AU - Balakrishna, Nagalla

AU - Bandosz, Piotr

AU - Barbagallo, Carlo M.

AU - Alberto Barceló, Barceló

AU - Batieha, Anwar M.

AU - Baur, Louise A.

AU - Romdhane, Habiba Ben

AU - Bernabe-Ortiz, Antonio

AU - Bhargava, Santosh K.

AU - Bi, Yufang

AU - Bjerregaard, Peter

AU - Björkelund, Cecilia

AU - Blake, Margaret

AU - Blokstra, Anneke

AU - Bo, Simona

AU - Boehm, Bernhard O.

AU - Boissonnet, Carlos P.

AU - Brajkovich, Imperia

AU - Breckenkamp, Juergen

AU - Brewster, Lizzy M.

AU - Brian, Garry R.

AU - Bruno, Graziella

AU - Bugge, Anna

AU - de León, Antonio Cabrera

AU - Can, Gunay

AU - Cândido, Ana Paula C.

AU - Capuano, Vincenzo

AU - Carvalho, Maria J.

AU - Casanueva, Felipe F.

AU - Caserta, Carmelo A.

AU - Castetbon, Katia

AU - Chamukuttan, Snehalatha

AU - Chaturvedi, Nishi

AU - Chen, Chien Jen

AU - Chen, Fangfang

AU - Chen, Shuohua

AU - Cheng, Ching Yu

AU - Chetrit, Angela

AU - Chiou, Shu Ti

AU - Cho, Yumi

AU - Chudek, Jerzy

AU - Cifkova, Renata

AU - Claessens, Frank

AU - Concin, Hans

AU - Cooper, Cyrus

AU - Cooper, Rachel

AU - Costanzo, Simona

AU - Cottel, Dominique

AU - Cowell, Chris

AU - Crujeiras, Ana B.

AU - D'Arrigo, Graziella

AU - Dallongeville, Jean

AU - Dankner, Rachel

AU - Dauchet, Luc

AU - de Gaetano, Giovanni

AU - de Henauw, Stefaan

AU - Deepa, Mohan

AU - Dehghan, Abbas

AU - Dhana, Klodian

AU - Di Castelnuovo, Augusto F.

AU - Djalalinia, Shirin

AU - Doua, Kouamelan

AU - Drygas, Wojciech

AU - Du, Yong

AU - Egbagbe, Eruke E.

AU - Eggertsen, Robert

AU - Ati, Jalila El

AU - Elosua, Roberto

AU - Erasmus, Rajiv T.

AU - Erem, Cihangir

AU - Ergor, Gul

AU - Eriksen, Louise

AU - Escobedo-de la Peña, Jorge

AU - Fall, Caroline H.

AU - Farzadfar, Farshad

AU - Felix-Redondo, Francisco J.

AU - Ferguson, Trevor S.

AU - Fernández-Bergés, Daniel

AU - Ferrari, Marika

AU - Ferreccio, Catterina

AU - Finn, Joseph D.

AU - Föger, Bernhard

AU - Foo, Leng Huat

AU - Fouad, Heba M.

AU - Francis, Damian K.

AU - do Carmo Franco, Maria

AU - Franco, Oscar H.

AU - Frontera, Guillermo

AU - Furusawa, Takuro

AU - Gaciong, Zbigniew

AU - Galbarczyk, Andrzej

AU - Garnett, Sarah P.

AU - Gaspoz, Jean Michel

AU - Gasull, Magda

AU - Gates, Louise

AU - Geleijnse, Johanna M.

AU - Ghasemain, Anoosheh

AU - Giampaoli, Simona

AU - Gianfagna, Francesco

AU - Giovannelli, Jonathan

AU - Gross, Marcela Gonzalez

AU - González Rivas, Juan P.

AU - Gorbea, Mariano Bonet

AU - Gottrand, Frederic

AU - Grant, Janet F.

AU - Grodzicki, Tomasz

AU - Grøntved, Anders

AU - Gruden, Grabriella

AU - Gu, Dongfeng

AU - Guan, Ong Peng

AU - Guerrero, Ramiro

AU - Guessous, Idris

AU - Guimaraes, Andre L.

AU - Gutierrez, Laura

AU - Hardy, Rebecca

AU - Kumar, Rachakulla Hari

AU - He, Jiang

AU - Heidemann, Christin

AU - Hihtaniemi, Ilpo Tapani

AU - Ho, Sai Yin

AU - Ho, Suzanne C.

AU - Hofman, Albert

AU - Russo Horimoto, Andrea R.V.

AU - Hormiga, Claudia M.

AU - Horta, Bernardo L.

AU - Houti, Leila

AU - Hussieni, Abdullatif S.

AU - Huybrechts, Inge

AU - Hwalla, Nahla

AU - Iacoviello, Licia

AU - Iannone, Anna G.

AU - Ibrahim, Mohsen M.

AU - Ikeda, Nayu

AU - Ikram, Arfan M.

AU - Irazola, Vilma E.

AU - Islam, Muhammad

AU - Iwasaki, Masanori

AU - Jacobs, Jeremy M.

AU - Jafar, Tazeen

AU - Jasienska, Grazyna

AU - Jiang, Chao Qiang

AU - Jonas, Jost B.

AU - Joshi, Pradeep

AU - Kafatos, Anthony

AU - Kalter-Leibovici, Ofra

AU - Kasaeian, Amir

AU - Katz, Joanne

AU - Kaur, Prabhdeep

AU - Kavousi, Maryam

AU - Kelishadi, Roya

AU - Kengne, Andre P.

AU - Kersting, Mathilde

AU - Khader, Yousef Saleh

AU - Kiechl, Stefan

AU - Kim, Jeongseon

AU - Kiyohara, Yutaka

AU - Kolsteren, Patrick

AU - Korrovits, Paul

AU - Koskinen, Seppo

AU - Kratzer, Wolfgang

AU - Kromhout, Daan

AU - Kula, Krzysztof

AU - Kurjata, Pawel

AU - Kyobutungi, Catherine

AU - Lachat, Carl

AU - Laid, Youcef

AU - Lam, Tai Hing

AU - Landrove, Orlando

AU - Lanska, Vera

AU - Lappas, Georg

AU - Laxmaiah, Avula

AU - Leclercq, Catherine

AU - Lee, Jeannette

AU - Lee, Jeonghee

AU - Lehtimäki, Terho

AU - Rampal, Lekhraj

AU - León-Muñoz, Luz M.

AU - Li, Yanping

AU - Lim, Wei Yen

AU - Fernanda Lima-Costa, M.

AU - Lin, Hsien Ho

AU - Lin, Xu

AU - Lissner, Lauren

AU - Lorbeer, Roberto

AU - Lozano, José Eugenio

AU - Lundqvist, Annamari

AU - Lytsy, Per

AU - Ma, Guansheng

AU - Machado-Coelho, George L.L.

AU - Machi, Suka

AU - Maggi, Stefania

AU - Makdisse, Marcia

AU - Rao, Kodavanti Mallikharjuna

AU - Manios, Yannis

AU - Manzato, Enzo

AU - Margozzini, Paula

AU - Marques-Vidal, Pedro

AU - Martorell, Reynaldo

AU - Masoodi, Shariq R.

AU - Matsha, Tandi E.

AU - Mbanya, Jean Claude N.

AU - McFarlane, Shelly R.

AU - McGarvey, Stephen T.

AU - McLachlan, Stela

AU - McNulty, Breige A.

AU - Mediene-Benchekor, Sounnia

AU - Meirhaeghe, Aline

AU - Menezes, Ana Maria B.

AU - Merat, Shahin

AU - Meshram, Indrapal I.

AU - Mi, Jie

AU - Miquel, Juan Francisco

AU - Mohamed, Mostafa K.

AU - Mohammad, Kazem

AU - Mohan, Viswanathan

AU - Yusoff, Muhammad Fadhli Mohd

AU - Moller, Niels C.

AU - Molnar, Denes

AU - Mondo, Charles K.

AU - Moreno, Luis A.

AU - Morgan, Karen

AU - Moschonis, George

AU - Mossakowska, Malgorzata

AU - Mostafa, Aya

AU - Mota, Jorge

AU - Muiesan, Maria L.

AU - Müller-Nurasyid, Martina

AU - Mursu, Jaakko

AU - Nagel, Gabriele

AU - Namesna, Jana

AU - Nang, Ei Ei K.

AU - Nangia, Vinay B.

AU - Navarrete-Muñoz, Eva Maria

AU - Ndiaye, Ndeye Coumba

AU - Nervi, Flavio

AU - Nguyen, Nguyen D.

AU - Nieto-Martínez, Ramfis E.

AU - Ning, Guang

AU - Ninomiya, Toshiharu

AU - Noale, Marianna

AU - Noto, Davide

AU - Ochoa-Avilés, Angélica M.

AU - Oh, Kyungwon

AU - Onat, Altan

AU - Osmond, Clive

AU - Otero, Johanna A.

AU - Palmieri, Luigi

AU - Panda-Jonas, Songhomitra

AU - Panza, Francesco

AU - Parsaeian, Mahboubeh

AU - Peixoto, Sergio Viana

AU - Pereira, Alexandre C.

AU - Peters, Annette

AU - Peykari, Niloofar

AU - Pilav, Aida

AU - Pitakaka, Freda

AU - Piwonska, Aleksandra

AU - Piwonski, Jerzy

AU - Plans-Rubió, Pedro

AU - Porta, Miquel

AU - Portegies, Marileen L.P.

AU - Poustchi, Hossein

AU - Pradeepa, Rajendra

AU - Price, Jacqueline F.

AU - Punab, Margus

AU - Qasrawi, Radwan F.

AU - Qorbani, Mostafa

AU - Raitakari, Olli

AU - Rao, Sudha Ramachandra

AU - Ramachandran, Ambady

AU - Ramos, Rafel

AU - Rampal, Sanjay

AU - Rathmann, Wolfgang

AU - Redon, Josep

AU - Reganit, Paul Ferdinand M.

AU - Rigo, Fernando

AU - Robinson, Sian M.

AU - Robitaille, Cynthia

AU - Rodríguez, Laura A.

AU - Rodríguez-Artalejo, Fernando

AU - Rodriguez-Perez, María del Cristo

AU - Rojas-Martinez, Rosalba

AU - Romaguera, Dora

AU - Rosengren, Annika

AU - Rubinstein, Adolfo

AU - Rui, Ornelas

AU - Ruiz-Betancourt, Blanca Sandra

AU - Rutkowski, Marcin

AU - Sabanayagam, Charumathi

AU - Sachdev, Harshpal S.

AU - Saidi, Olfa

AU - Sakarya, Sibel

AU - Salanave, Benoit

AU - Salonen, Jukka T.

AU - Salvetti, Massimo

AU - Sánchez-Abanto, Jose

AU - dos Santos, Renata Nunes

AU - Santos, Rute

AU - Sardinha, Luis B.

AU - Scazufca, Marcia

AU - Schargrodsky, Herman

AU - Scheidt-Nave, Christa

AU - Shibuya, Kenji

AU - Shin, Youchan

AU - Shiri, Rahman

AU - Siantar, Rosalynn

AU - Sibai, Abla M.

AU - Simon, Mary

AU - Simons, Judith

AU - Simons, Leon A.

AU - Sjostrom, Michael

AU - Slowikowska-Hilczer, Jolanta

AU - Slusarczyk, Przemyslaw

AU - Smeeth, Liam

AU - Snijder, Marieke B.

AU - Solfrizzi, Vincenzo

AU - Sonestedt, Emily

AU - Soumare, Aicha

AU - Staessen, Jan A.

AU - Steene-Johannessen, Jostein

AU - Stehle, Peter

AU - Stein, Aryeh D.

AU - Stessman, Jochanan

AU - Stöckl, Doris

AU - Stokwiszewski, Jakub

AU - Strufaldi, Maria Wany

AU - Sun, Chien An

AU - Sundström, Johan

AU - Suriyawongpaisal, Paibul

AU - Sy, Rody G.

AU - Tai, E. Shyong

AU - Tarawneh, Mohammed

AU - Tarqui-Mamani, Carolina B.

AU - Thijs, Lutgarde

AU - Tolstrup, Janne S.

AU - Topbas, Murat

AU - Torrent, Maties

AU - Traissac, Pierre

AU - Trinh, Oanh T.H.

AU - Tulloch-Reid, Marshall K.

AU - Tuomainen, Tomi Pekka

AU - Turley, Maria L.

AU - Tzourio, Christophe

AU - Ueda, Peter

AU - Ukoli, Flora M.

AU - Ulmer, Hanno

AU - Valdivia, Gonzalo

AU - van Valkengoed, Irene G.M.

AU - Vanderschueren, Dirk

AU - Vanuzzo, Diego

AU - Vega, Tomas

AU - Velasquez-Melendez, Gustavo

AU - Veronesi, Giovanni

AU - Verschuren, Monique

AU - Vioque, Jesus

AU - Virtanen, Jyrki

AU - Visvikis-Siest, Sophie

AU - Viswanathan, Bharathi

AU - Vollenweider, Peter

AU - Voutilainen, Sari

AU - Wade, Alisha N.

AU - Wagner, Aline

AU - Walton, Janette

AU - Mohamud, Wan Nazaimoon Wan

AU - Wang, Ming Dong

AU - Wang, Ya Xing

AU - Wannamethee, S. Goya

AU - Weerasekera, Deepa

AU - Whincup, Peter H.

AU - Widhalm, Kurt

AU - Wiecek, Andrzej

AU - Wilks, Rainford J.

AU - Willeit, Johann

AU - Wojtyniak, Bogdan

AU - Wong, Tien Yin

AU - Woo, Jean

AU - Woodward, Mark

AU - Wu, Aleksander Giwercman

AU - Wu, Frederick C.

AU - Wu, Shou Ling

AU - Xu, Haiquan

AU - Yang, Xiaoguang

AU - Ye, Xingwang

AU - Yoshihara, Akihiro

AU - Younger-Coleman, Novie O.

AU - Zambon, Sabina

AU - Zargar, Abdul Hamid

AU - Zdrojewski, Tomasz

AU - Zhao, Wenhua

AU - Zheng, Yingfeng

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.

AB - Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.

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U2 - 10.1016/S2213-8587(15)00129-1

DO - 10.1016/S2213-8587(15)00129-1

M3 - Article

C2 - 26109024

AN - SCOPUS:84938199196

VL - 3

SP - 624

EP - 637

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 8

ER -