Endocrine Abstracts

The number of the people with type 2 diabetes is increasing globally, therefore there is an increasing need to identify diabetes earlier and more efficiently. Nearly 80% of people with diabetes live in low and middle income countries (LMICs). Traditionally, we have relied on glucose-based criteria (fasting, postprandial, and random) to make the diagnosis of diabetes; however, HbA1c has recently been endorsed as a diagnostic test, as superior alternative to glucose-based criteria. It is still controversy about implementation of HbA1c criteria in LMICs especially due to several cons one of them being high cost. Previous studies have suggested that some degree of discrepancies exist between the HbA1c and glucose based criteria and may vary by race, ethnicity, sex, and age in various populations. Hence, we aimed to access the discrepancies between the new HbA1c-based criteria over glucose-based criteria for diagnosis of diabetes and pre-diabetes among clinically diagnosed Nepalese population. A total of 1277 clinically suspected type 2 diabetes and prediabetes, who attended Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal between January 2012 and April 2014 were recruited in the study. Initial screening was carried out using the FINDRISC questionnaire. The American Diabetes Association (ADA)-glucose based and ADA-HbA1c criterions were used to diagnose diabetes and pre-diabetes. The discrepancies between two criteria to diagnose pre-diabetes and diabetes were evaluated. Significant discordance exists between the HbA1c- and glucose-based criteria for diagnosis of diabetes in Nepalese population. Furthermore, the substantial numbers of subjects with pre-diabetes were missed by HbA1c criterion.