Iranian Red Crescent Medical Journal

Published by: Kowsar

Optimal Glycemic and Hemoglobin A1c Thresholds for Diagnosing Diabetes Based on Prevalence of Retinopathy in an Iranian Population

Naser Samadi Aidenloo 1 , Alireza Mehdizadeh 2 , * , Neda Valizadeh 2 , Mohammad Abbaszadeh 1 , Siavash Qarequran 2 and Hamidreza Khalkhali 3
Authors Information
1 Department of Ophthalmology, Urmia University of Medical Sciences, Urmia, IR Iran
2 Department of Endocrinology, Urmia University of Medical Sciences, Urmia, IR Iran
3 Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, IR Iran
Article information
  • Iranian Red Crescent Medical Journal: August 01, 2016, 18 (8); e31254
  • Published Online: June 21, 2016
  • Article Type: Research Article
  • Received: July 3, 2015
  • Revised: September 15, 2015
  • Accepted: October 7, 2015
  • DOI: 10.5812/ircmj.31254

To Cite: Samadi Aidenloo N, Mehdizadeh A, Valizadeh N, Abbaszadeh M, Qarequran S, et al. Optimal Glycemic and Hemoglobin A1c Thresholds for Diagnosing Diabetes Based on Prevalence of Retinopathy in an Iranian Population, Iran Red Crescent Med J. 2016 ; 18(8):e31254. doi: 10.5812/ircmj.31254.

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion
  • 1. American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33: 62-9[DOI][PubMed]
  • 2. Xin Z, Yuan MX, Li HX, Hua L, Feng JP, Shi J, et al. Evaluation for fasting and 2-hour glucose and HbA1c for diagnosing diabetes based on prevalence of retinopathy in a Chinese population. PLoS One. 2012; 7(7): 40610[DOI][PubMed]
  • 3. McCance DR, Hanson RL, Pettitt DJ, Bennett PH, Hadden DR, Knowler WC. Diagnosing diabetes mellitus--do we need new criteria? Diabetologia. 1997; 40(3): 247-55[DOI][PubMed]
  • 4. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010; 376(9735): 124-36[DOI][PubMed]
  • 5. Wong TY, Liew G, Tapp RJ, Schmidt MI, Wang JJ, Mitchell P, et al. Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies. Lancet. 2008; 371(9614): 736-43[DOI][PubMed]
  • 6. Colagiuri S, Lee CM, Wong TY, Balkau B, Shaw JE, Borch-Johnsen K, et al. Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes. Diabetes Care. 2011; 34(1): 145-50[DOI][PubMed]
  • 7. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997; 20(7): 1183-97[PubMed]
  • 8. McCance DR, Hanson RL, Charles MA, Jacobsson LT, Pettitt DJ, Bennett PH, et al. Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. BMJ. 1994; 308(6940): 1323-8[PubMed]
  • 9. Mukai N, Yasuda M, Ninomiya T, Hata J, Hirakawa Y, Ikeda F, et al. Thresholds of various glycemic measures for diagnosing diabetes based on prevalence of retinopathy in community-dwelling Japanese subjects: the Hisayama Study. Cardiovasc Diabetol. 2014; 13: 45[DOI][PubMed]
  • 10. Park YM, Ko SH, Lee JM, Kim DJ, Kim DJ, Han K, et al. Glycaemic and haemoglobin A1c thresholds for detecting diabetic retinopathy: the fifth Korea National Health and Nutrition Examination Survey (2011). Diabetes Res Clin Pract. 2014; 104(3): 435-42[DOI][PubMed]
  • 11. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6): 1364-79[DOI][PubMed]
  • 12. Ko SH, Kim SR, Kim DJ, Oh SJ, Lee HJ, Shim KH, et al. 2011 clinical practice guidelines for type 2 diabetes in Korea. Diabetes Metab J. 2011; 35(5): 431-6[DOI][PubMed]
  • 13. Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes M, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010; 1(5): 212-28[DOI][PubMed]
  • 14. Cheng YJ, Gregg EW, Geiss LS, Imperatore G, Williams DE, Zhang X, et al. Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: Implications for diabetes diagnostic thresholds. Diabetes Care. 2009; 32(11): 2027-32[DOI][PubMed]
  • 15. Miyazaki M, Kubo M, Kiyohara Y, Okubo K, Nakamura H, Fujisawa K, et al. Comparison of diagnostic methods for diabetes mellitus based on prevalence of retinopathy in a Japanese population: the Hisayama Study. Diabetologia. 2004; 47(8): 1411-5[DOI][PubMed]
  • 16. Sivaprasad S, Gupta B, Gulliford MC, Dodhia H, Mohamed M, Nagi D, et al. Ethnic variations in the prevalence of diabetic retinopathy in people with diabetes attending screening in the United Kingdom (DRIVE UK). PLoS One. 2012; 7(3): 32182[DOI][PubMed]
  • 17. Engelgau MM, Thompson TJ, Herman WH, Boyle JP, Aubert RE, Kenny SJ, et al. Comparison of fasting and 2-hour glucose and HbA1c levels for diagnosing diabetes. Diagnostic criteria and performance revisited. Diabetes Care. 1997; 20(5): 785-91[PubMed]
  • 18. Tapp RJ, Zimmet PZ, Harper CA, de Courten MP, McCarty DJ, Balkau B, et al. Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia. Diabetes Res Clin Pract. 2006; 73(3): 315-21[DOI][PubMed]
  • 19. van Leiden HA, Dekker JM, Moll AC, Nijpels G, Heine RJ, Bouter LM, et al. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study. Arch Ophthalmol. 2003; 121(2): 245-51[PubMed]
  • 20. Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009; 15(3): 591-9[PubMed]
  • 21. Wilkinson CP, Ferris F3, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003; 110(9): 1677-82[DOI][PubMed]
  • 22. Schisterman EF, Faraggi D, Reiser B, Hu J. Youden Index and the optimal threshold for markers with mass at zero. Stat Med. 2008; 27(2): 297-315[DOI][PubMed]
  • 23. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3): 837-45[PubMed]
  • 24. Cho NH, Kim TH, Woo SJ, Park KH, Lim S, Cho YM, et al. Optimal HbA1c cutoff for detecting diabetic retinopathy. Acta Diabetol. 2013; 50(6): 837-42[DOI][PubMed]
  • 25. Mohan V, Sandeep S, Deepa M, Gokulakrishnan K, Datta M, Deepa R. A diabetes risk score helps identify metabolic syndrome and cardiovascular risk in Indians - the Chennai Urban Rural Epidemiology Study (CURES-38). Diabetes Obes Metab. 2007; 9(3): 337-43[DOI][PubMed]
  • 26. Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, et al. Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology. 2008; 115(11): 1869-75[DOI][PubMed]
  • 27. Massin P, Lange C, Tichet J, Vol S, Erginay A, Cailleau M, et al. Hemoglobin A1c and fasting plasma glucose levels as predictors of retinopathy at 10 years: the French DESIR study. Arch Ophthalmol. 2011; 129(2): 188-95[DOI][PubMed]
  • 28. Malkani S, Mordes JP. Implications of using hemoglobin A1C for diagnosing diabetes mellitus. Am J Med. 2011; 124(5): 395-401[DOI][PubMed]
  • 29. International Expert C. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009; 32(7): 1327-34[DOI][PubMed]
  • 30. Ito C. Evidence for diabetes mellitus criteria in 2010 using HbA1c. Diabetology International. 2012; 4(1): 9-15[DOI]
  • 31. Waugh NR, Shyangdan D, Taylor-Phillips S, Suri G, Hall B. Screening for type 2 diabetes: a short report for the National Screening Committee. Health Technol Assess. 2013; 17(35): 1-90[DOI][PubMed]
  • 32. Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011; 34: 184-90[DOI][PubMed]
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