Diagnostic performance of HbA1c for diabetes in Arab vs. European populations: a systematic review and meta-analysis
Recommended Citation
Bertran EA, Berlie HD, Taylor A, Divine G, and Jaber LA. Diagnostic performance of HbA for diabetes in Arab vs. European populations: a systematic review and meta-analysis. Diabet Med 2016;34(2):156-166.
Document Type
Article
Publication Date
2-1-2017
Publication Title
Diabetic medicine
Abstract
Aim: To examine differences in the performance of HbA1c for diagnosing diabetes in Arabs compared with Europeans.
Methods: The PubMed, Embase and Cochrane library databases were searched for records published between 1998 and 2015. Estimates of sensitivity, specificity and log diagnostic odds ratios for an HbA1c cut-point of 48 mmol/mol (6.5%) were compared between Arabs and Europeans, using a bivariate linear mixed-model approach. For studies reporting multiple cut-points, population-specific summary receiver operating characteristic (SROC) curves were constructed. In addition, sensitivity, specificity and Youden Index were estimated for strata defined by HbA1c cut-point and population type. Database searches yielded 1912 unique records; 618 full-text articles were reviewed. Fourteen studies met the inclusion criteria; hand-searching yielded three additional eligible studies. Three Arab (N = 2880) and 16 European populations (N = 49 127) were included in the analysis.
Results: Summary sensitivity and specificity for a HbA1c cut-point of 48 mmol/mol (6.5%) in both populations were 42% (33-51%), and 97% (95-98%). There was no difference in area under SROC curves between Arab and European populations (0.844 vs. 0.847; P = 0.867), suggesting no difference in HbA1c diagnostic accuracy between populations. Multiple cut-point summary estimates stratified by population suggest that Arabs have lower sensitivity and higher specificity at a HbA1c cut-point of 44 mmol/mol (6.2%) compared with European populations. Estimates also suggest similar test performance at cut-points of 44 mmol/mol (6.2%) and 48 mmol/mol (6.5%) for Arabs.
Conclusions: Given the low sensitivity of HbA1c in the high-risk Arab American population, we recommend a combination of glucose-based and HbA1c testing to ensure an accurate and timely diagnosis of diabetes.
Medical Subject Headings
Arabs; Blood Glucose; Diabetes Mellitus; Glycated Hemoglobin; Humans; ROC Curve; Sensitivity and Specificity; White People
PubMed ID
26996656
Volume
34
Issue
2
First Page
156
Last Page
166
