Detecting prediabetes among Hispanics/Latinos from diverse heritage groups: Does the test matter? Findings from the Hispanic Community Health Study/Study of Latinos

Abstract

The objectives of this analysis were to compare the ability of fasting plasma glucose (FPG), post oral load plasma glucose (2hPG), and hemoglobin A_1c (HbA_1c) to identify U.S. Hispanic/Latino individuals with prediabetes, and to assess its cardiovascular risk factor correlates. This is a cross-sectional analysis of baseline data from 15,507 adults without self-reported diabetes mellitus from six Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos, which takes place in four U.S. communities. The prevalence of prediabetes was determined according to individual or combinations of ADA-defined cut points: FPG=5.6-7.0mmol/L, 2hPG=7.8-11.1mmol/L, and HbA_1c=5.7%-6.4% (39-46mmol/mol). The sensitivity of these criteria to detect prediabetes was estimated. The prevalence ratios (PRs) for selected cardiovascular risk factors were compared among alternative categories of prediabetes versus normoglycemia [FPG<5.6mmol/L and 2hPG<7.8mmol/L and HbA_1c<5.7% (39mmol/mol)]. Approximately 36% of individuals met any of the ADA prediabetes criteria. Using 2hPG as the gold standard, the sensitivity of FPG was 40.1%, HbA_1c was 45.6%, and that of HbA_1c+FPG was 62.2%. The number of significant PRs for cardiovascular risk factors was higher among individuals with isolated 2hPG=7.8-11.1mmol/L, FPG=5.6-7.0mmol/L+HbA_1c=5.7%-6.4%, or those who met the three prediabetes criteria. Assessing FPG, HbA_1c, and cardiovascular risk factors in Hispanics/Latinos at risk might enhance the early prevention of diabetes mellitus and cardiovascular complications in this young and growing population, independent of their heritage group.

Keywords: Hispanics; Hypertension; LDL cholesterol; Latinos; Obesity; Prediabetic state; Triglycerides.

Figure 1. Venn Diagram of the Distribution of Pre-Diabetes Glycemic Criteria

The percentages are based on n = 15,507. (Baseline HCHS/SOL study data, 2008–2011) Total IFG = IFG + (either normal 2hPG or IGT) + (either normal or impaired HbA_1c); Total IGT = IGT + (either normal FPG or IFG) + (either normal or impaired HbA_1c); Total Impaired HbA_1c = Impaired HbA_1c + (either normal FPG or IFG) + (either normal 2hPG or IGT); Isolated IFG = IFG + normal 2hPG + normal HbA_1c; Isolated IGT = IGT + normal FPG + normal HbA_1c; Isolated HbA_1c = Impaired HbA_1c + normal FPG + normal 2hPG. The three main glycemic categories showed considerable overlap. Over half of individuals with Impaired HbA_1c (57%), IFG (61%) and IGT (64%) had them combined with at least another glycemic abnormality. Almost 4% of the target population (or 10% of the population with prediabetes) met all three prediabetes glycemic criteria.

Figure 2. Adjusted Prevalence Ratios of Selected Cardiovascular Risk Factors by Glycemic Category

Prevalence ratios were weighted and adjusted for age and Hispanic/Latino heritage group. (Baseline HCHS/SOL study data, 2008–2011).

Figure 3. Adjusted Prevalence Ratios of Selected Cardiovascular Risk Factors by Glycemic Category

Prevalence ratios were weighted and adjusted for age and Hispanic/Latino heritage group. (Baseline HCHS/SOL study data, 2008–2011).