Inequity of diagnosis of diabetes by plasma glucose and HbA1c.

Objective: Both plasma glucose and glycosylated hemoglobin are the recommended tools to diagnose diabetes by the International Expert Committee and World Health Organization (WHO). The aim of this study was to compare these two parameters in the diagnosis of diabetes in a selected group of Bangladeshi subjects. Materials and Methods: This cross-sectional study included 800 subjects attending the outdoor in a tertiary healthcare center during the period of September 2009 to September 2010. Fasting, postprandial (2 hours after glucose load) plasma glucose and HbA1c were measured. Diabetes is defined according to HbA1c and plasma glucose. Subjects were classified into three groups according to HbA1c values (HbA1c: =6.5%, HbA1c: 6.0-6.4% and HbA1c: < 6.0%) and also in the diabetics, prediabetics (IGT+IFG) and nondiabetics by plasma glucose. Results of the HbA1c classified subjects were compared with the plasma glucose classified subjects to see the inequity of classification. Results: Inequity of classification occurred for 11.87% of the total subjects with HbA1c =6.5% but impaired (8.25%) and nondiabetic (3.62%) by plasma glucose; for 10.13% of the subjects with HbA1c: 6.0-6.4% but diabetic (3.25%) and nondiabetic (6.88%) by plasma glucose, and for 8.5% of the total subjects with HbA1c <6.0% but diabetic (1.88%) and impaired (6.62%) by plasma glucose. Concordant classification occurred for 69.5% and inequity of classification occurred for 30.5% of the total study subjects. Conclusion: Inequity of classification of diabetes by HbA1c and plasma glucose is remarkable in the study population.

Comparison of C-reactive protein among controlled, moderately controlled and uncontrolled diabetic subjects in a Bangladeshi population.

Poor glycemic control is significantly associated with the development of macrovascular complications of diabetes. C-reactive protein (CRP) is considered as a sensitive and independent risk factor for cardiovascular events. The aim of this study was to compare elevated CRP among controlled, moderately controlled and uncontrolled diabetic subjects in a Bangladeshi population. CRP and glycosylated hemoglobin A1c (HbA1c) were measured in 226 confirmed diabetic subjects purposively and randomly. Elevation of CRP in the moderately controlled (relative risk 1.64, P<0.01) and uncontrolled diabetic subjects (relative risk 1.8, P<0.001) were significantly higher than controlled diabetic subjects. HbA1c was significantly associated with the likelihood of elevated CRP in the moderately controlled diabetic subjects (OR:2.87, 95% CI: 1.41 to 5.87, P<0.01) and in the uncontrolled diabetic subjects (OR:3.83, 95% CI: 1.94 to 7.58, P<0.001). This study revealed that the likelihood of elevated CRP is associated with the increase of HbA1c in diabetic subjects.