IDENTIFYING PROBABLE DIABETES MELLITUS AMONG HISPANICS/LATINOS FROM FOUR U.S. CITIES: FINDINGS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS

Abstract

Objective: The aim of this study was to compare the ability of American Diabetes Association (ADA) diagnostic criteria to identify U.S. Hispanics/Latinos from diverse heritage groups with probable diabetes mellitus and assess cardiovascular risk factor correlates of those criteria.

Methods: Cross-sectional analysis of data from 15,507 adults from 6 Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos. The prevalence of probable diabetes mellitus was estimated using individual or combinations of ADA-defined cut points. The sensitivity and specificity of these criteria at identifying diabetes mellitus from ADA-defined prediabetes and normoglycemia were evaluated. Prevalence ratios of hypertension, abnormal lipids, and elevated urinary albumin-creatinine ratio for unrecognized diabetes mellitus-versus prediabetes and normoglycemia-were calculated.

Results: Among Hispanics/Latinos (mean age, 43 years) with diabetes mellitus, 39.4% met laboratory test criteria for probable diabetes, and the prevalence varied by heritage group. Using the oral glucose tolerance test as the gold standard, the sensitivity of fasting plasma glucose (FPG) and hemoglobin A1c-alone or in combination-was low (18, 23, and 33%, respectively) at identifying probable diabetes mellitus. Individuals who met any criterion for probable diabetes mellitus had significantly higher (P<.05) prevalence of most cardiovascular risk factors than those with normoglycemia or prediabetes, and this association was not modified by Hispanic/Latino heritage group.

Conclusion: FPG and hemoglobin A1c are not sensitive (but are highly specific) at detecting probable diabetes mellitus among Hispanics/Latinos, independent of heritage group. Assessing cardiovascular risk factors at diagnosis might prompt multitarget interventions and reduce health complications in this young population.

Abbreviations: 2hPG = 2-hour post-glucose load plasma glucose ADA = American Diabetes Association BMI = body mass index CV = cardiovascular FPG = fasting plasma glucose HbA1c = hemoglobin A1c HCHS/SOL = Hispanic Community Health Study/Study of Latinos HDL-C = high-density-lipoprotein cholesterol NGT = normal glucose tolerance NHANES = National Health and Nutrition Examination Survey OGTT = oral glucose tolerance test TG = triglyceride UACR = urine albumin-creatinine ratio.

Figure 1. Venn Diagram of the Distribution of Probable Diabetes Mellitus Glycemic Criteria

The percentages are based on the target population, n = 15,507. Total FPG (2.3%) = FPG ≥ 7.1 mmol/L + any 2hPG + any HbA_1c; Isolated FPG (0.2%) = FPG ≥ 7.1 mmol/L + normal 2hPG + normal HbA_1c FPG + 2hPG + other HbA_1c (0.2%) = FPG ≥ 7.1 mmol/L + 2hPG ≥ 11.2 mmol/L + HbA_1c within normal or pre-diabetes range; FPG + HbA_1c + other 2hPG (1.3%) = FPG ≥ 7.1 mmol/L + HbA_1c ≥ 48 mmol/mol + 2hPG within normal or pre-diabetes range; Total 2hPG (4.4%) = 2hPG ≥ 11.2 mmol/L + any FPG + any HbA_1c; Isolated 2hPG (3.0%) = 2hPG ≥ 11.2 mmol/L + normal FPG + normal HbA_1c 2hPG + HbA_1c + other FPG (0.6%) = 2hPG ≥ 11.2 mmol/L + HbA_1c ≥ 48 mmol/mol + FPG within normal or pre-diabetes range Total HbA_1c ≥ 6.5% (3.3%) = HbA_1c ≥ 48 mmol/mol + any FPG + any 2hPG; Isolated HbA_1c ≥ 6.5% (0.7%) = HbA_1c ≥ 48 mmol/mol + normal FPG + normal 2hPG Total FPG + 2hPG + HbA_1c (0.6%) = FPG ≥ 7.1 mmol/L + 2hPG ≥ 11.2 mmol/L + HbA_1c ≥ 48 mmol/mol