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00925njm 22002777a 4500 dc Danaei, Goodarz author Fahimi, Saman author Lu, Yuan author Zhou, Bin author Hajifathalian, Kaveh author Di Cesare, Mariachiara author Lo, Wei-Cheng author Reis-Santos, Barbara author Cowan, Melanie J author Shaw, Jonathan E author Bentham, James author Lin, John K author Bixby, Honor author Magliano, Dianna author Bovet, Pascal author Miranda, J. Jaime author Khang, Young-Ho author Stevens, Gretchen A author Riley, Leanne M author Ali, Mohammed K author Ezzati, Majid author Abdeen, Ziad A author Kadir, Khalid Abdul author Abu-Rmeileh, Niveen M author Acosta-Cazares, Benjamin author Aekplakorn, Wichai author Aguilar-Salinas, Carlos A author Ahmadvand, Alireza author Al Nsour, Mohannad author Alkerwi, Ala'a author Amouyel, Philippe author Andersen, Lars Bo author Anderssen, Sigmund A author Andrade, Dolores S author Anjana, Ranjit Mohan author Aounallah-Skhiri, Hajer author Aris, Tahir author Arlappa, Nimmathota author Arveiler, Dominique author Assah, Felix K author Avdicova, Maria author Balakrishna, Nagalla author Bandosz, Piotr author Barbagallo, Carlo M author Barcelo, Alberto author Batieha, Anwar M author Baur, Louise A author Ben Romdhane, Habiba author Bernabe-Ortiz, Antonio author Bhargava, Santosh K author Bi, Yufang author Bjerregaard, Peter author Bjorkelund, Cecilia author Blake, Margaret author Blokstra, Anneke author Bo, Simona author Boehm, Bernhard O author Boissonnet, Carlos P author Bovet, Pascal author Brajkovich, Imperia author Breckenkamp, Juergen author Brewster, Lizzy M author Brian, Garry R author Bruno, Graziella author Bugge, Anna author de Leon, Antonio Cabrera author Can, Gunay author Candido, Ana Paula C author Capuano, Vincenzo author Carvalho, Maria J author Casanueva, Felipe F author Caserta, Carmelo A author Castetbon, Katia author Chamukuttan, Snehalatha author Chaturvedi, Nishi author Chen, Chien-Jen author Chen, Fangfang author Chen, Shuohua author Cheng, Ching-Yu author Chetrit, Angela author Chiou, Shu-Ti author Cho, Yumi author Chudek, Jerzy author Cifkova, Renata author Claessens, Frank author Concin, Hans author Cooper, Cyrus author Cooper, Rachel author Costanzo, Simona author Cottel, Dominique author Cowell, Chris author Crujeiras, Ana B author D'Arrigo, Graziella author Dallongeville, Jean author Dankner, Rachel S author Dauchet, Luc author de Gaetano, Giovanni author De Henauw, Stefaan author Deepa, Mohan author Dehghan, Abbas author Dhana, Klodian author Di Castelnuovo, Augusto F author Djalalinia, Shirin author Doua, Kouamelan author Drygas, Wojciech author Du, Yong author Egbagbe, Eruke E author Eggertsen, Robert author El Ati, Jalila author Elosua, Roberto author Erasmus, Rajiv T author Erem, Cihangir author Ergor, Gul author Eriksen, Louise author la Penaa, Jorge Escobedo-De author Fall, Caroline H author Farzadfar, Farshad author Felix-Redondo, Francisco J author Ferguson, Trevor S author Fernandez-Berges, Daniel author Ferrari, Marika author Ferreccio, Catterina author Finn, Joseph D author Foger, Bernhard author Foo, Leng Huat author Fouad, Heba M author Francis, Damian K author do Carmo Franco, Maria author Franco, Oscar H author Frontera-Juan, Guillem author Furusawa, Takuro author Gaciong, Zbigniew author Galbarczyk, Andrzej author Garnett, Sarah P author Gaspoz, Jean-Michel author Gasull, Magda author Gates, Louise author Geleijnse, Johanna M author Ghasemain, Anoosheh author Giampaoli, Simona author Gianfagna, Francesco author Giovannelli, Jonathan author Gross, Marcela Gonzalez author Rivas, Juan P. Gonzalez author Gorbea, Mariano Bonet author Gottrand, Frederic author Grant, Janet F author Grodzicki, Tomasz author Grontved, Anders author Gruden, Grabriella author Gu, Dongfeng author Guan, Ong Peng author Guerrero, Ramiro author Guessous, Idris author Guimaraes, Andre L author Gutierrez, Laura author Hardy, Rebecca author Kumar, Rachakulla Hari author He, Jiang author Heidemann, Christin author Hihtaniemi, Ilpo Tapani author Ho, Sai Yin author Ho, Suzanne C author Hofman, Albert author Russo, Andrea R. V author Hormiga, Claudia M author Horta, Bernardo L author Houti, Leila author Hussieni, Abdullatif S author Huybrechts, Inge author Hwalla, Nahla author Iacoviello, Licia author Iannone, Anna G author Ibrahim, Mohsen M author Ikeda, Nayu author Ikram, M. Arfan author Irazola, Vilma E author Islam, Muhammad author Iwasaki, Masanori author Jacobs, Jeremy M author Jafar, Tazeen author Jasienska, Grazyna author Jiang, Chao Qiang author Jonas, Jost B author Joshi, Pradeep author Kafatos, Anthony author Kalter-Leibovici, Ofra author Kasaeian, Amir author Katz, Joanne author Kaur, Prabhdeep author Kavousi, Maryam author Kelishadi, Roya author Kengne, Andre P author Kersting, Mathilde author Khader, Yousef Saleh author Khang, Young-Ho author Kiechl, Stefan author Kim, Jeongseon author Kiyohara, Yutaka author Kolsteren, Patrick author Korrovits, Paul author Koskinen, Seppo author Kratzer, Wolfgang author Kromhout, Daan author Kula, Krzysztof author Kurjata, Pawel author Kyobutungi, Catherine author Lachat, Carl author Laid, Youcef author Lam, Tai Hing author Landrove, Orlando author Lanska, Vera author Lappas, Georg author Laxmaiah, Avula author Leclercq, Catherine author Lee, Jeannette author Lee, Jeonghee author Lehtimaki, Terho author Lekhraj, Rampal author Leon-Munoz, Luz M author Li, Yanping author Lim, Wei-Yen author Lima-Costa, M. Fernanda author Lin, Hsien-Ho author Lin, Xu author Lissner, Lauren author Lorbeer, Roberto author Lozano, Jose Eugenio author Lundqvist, Annamari author Lytsy, Per author Ma, Guansheng author Machado-Coelho, George L. L author Machi, Suka author Maggi, Stefania author Magliano, Dianna author Makdisse, Marcia author Rao, Kodavanti Mallikharjuna author Manios, Yannis author Manzato, Enzo author Margozzini, Paula author Marques-Vidal, Pedro author Martorell, Reynaldo author Masoodi, Shariq R author Matsha, Tandi E author Mbanya, Jean Claude N author McFarlane, Shelly R author McGarvey, Stephen T author McLachlan, Stela author McNulty, Breige A author Mediene-Benchekor, Sounnia author Meirhaeghe, Aline author Menezes, Ana Maria B author Merat, Shahin author Meshram, Indrapal I author Mi, Jie author Miquel, Juan Francisco author Miranda, J. Jaime author Mohamed, Mostafa K author Mohammad, Kazem author Mohan, Viswanathan author Yusoff, Muhammad Fadhli Mohd author Moller, Niels C author Molnar, Denes author Mondo, Charles K author Moreno, Luis A author Morgan, Karen author Moschonis, George author Mossakowska, Malgorzata author Mostafa, Aya author Mota, Jorge author Muiesan, Maria L author Muller-Nurasyid, Martina author Mursu, Jaakko author Nagel, Gabriele author Namesna, Jana author Nang, Ei Ei K author Nangia, Vinay B author Navarrete-Muñoz, Eva María author Ndiaye, Ndeye Coumba author Nervi, Flavio author Nguyen, Nguyen D author Nieto-Martinez, Ramfi S. E author Ning, Guang author Ninomiya, Toshiharu author Noale, Marianna author Noto, Davide author Ochoa-Aviles, Angelica M author Oh, Kyungwon author Onat, Altan author Osmond, Clive author Otero, Johanna A author Palmieri, Luigi author Panda-Jonas, Songhomitra author Panza, Francesco author Parsaeian, Mahboubeh author Peixoto, Sergio Viana author Peters, Annette author Peykari, Niloofar author Pilav, Aida author Pitakaka, Freda author Piwonska, Aleksandra author Piwonski, Jerzy author Plans-Rubio, Pedro author Porta, Miquel author Portegies, Marileen L. P author Poustchi, Hossein author Pradeepa, Rajendra author Price, Jacqueline F author Punab, Margus author Qasrawi, Radwan F author Qorbani, Mostafa author Raitakari, Olli author Rao, Sudha Ramachandra author Ramachandran, Ambady author Ramos-Asensio, Rafael author Rampal, Sanjay author Rathmann, Wolfgang author Redon, Josep author Reganit, Paul Ferdinand M author Reigada Mendez, Rebeca author Robinson, Sian M author Robitaille, Cynthia author Rodriguez, Laura A author Rodríguez-Artalejo, Fernando author Rodriguez-Perez, Maria Del Cristo author Rojas-Martinez, Rosalba author Romaguera, Dora author Rosengren, Annika author Rubinstein, Adolfo author Rui, Ornelas author Ruiz-Betancourt, Blanca Sandra author Rutkowski, Marcin author Sabanayagam, Charumathi author Sachdev, Harshpal S author Saidi, Olfa author Sakarya, Sibel author Salanave, Benoit author Salonen, Jukka T author Salvetti, Massimo author Sanchez-Abanto, Jose author Nunes, Renata author Santos, Rute author Sardinha, Luis B author Scazufca, Marcia author Schargrodsky, Herman author Scheidt-Nave, Christa author Shaw, Jonathan E author Shibuya, Kenji author Shin, Youchan author Shiri, Rahman author Siantar, Rosalynn author Sibai, Abla M author Simon, Mary author Simons, Judith author Simons, Leon A author Sjostrom, Michael author Slowikowska-Hilczer, Jolanta author Slusarczyk, Przemyslaw author Smeeth, Liam author Snijder, Marieke B author Solfrizzi, Vincenzo author Sonestedt, Emily author Soumare, Aicha author Staessen, Jan A author Steene-Johannessen, Jostein author Stehle, Peter author Stein, Aryeh D author Stessman, Jochanan author Stockl, Doris author Stokwiszewski, Jakub author Strufaldi, Maria Wany author Sun, Chien-An author Sundstrom, Johan author Suriyawongpaisal, Paibul author Sy, Rody G author Tai, E-Shyong author Tarawneh, Mohammed author Tarqui-Mamani, Carolina B author Thijs, Lutgarde author Tolstrup, Janne S author Topbas, Murat author Torrent Quetglas, Maties author Traissac, Pierre author Trinh, Oanh T. H author Tulloch-Reid, Marshall K author Tuomainen, Tomi-Pekka author Turley, Maria L author Tzourio, Christophe author Ueda, Peter author Ukoli, Flora M author Ulmer, Hanno author Valdivia, Gonzalo author Van Valkengoed, Irene G. M author Vanderschueren, Dirk author Vanuzzo, Diego author Vega, Tomás author Velasquez-Melendez, Gustavo author Veronesi, Giovanni author Verschuren, Monique author Virtanen, Jyrki author Visvikis-Siest, Sophie author Viswanathan, Bharathi author Vollenweider, Peter author Voutilainen, Sari author Wade, Alisha N author Wagner, Aline author Walton, Janette author Mohamud, Wan Nazaimoon Wan author Wang, Ming-Dong author Wang, Ya Xing author Wannamethee, S. Goya author Weerasekera, Deepa author Whincup, Peter H author Widhalm, Kurt author Wiecek, Andrzej author Wilks, Rainford J author Willeit, Johann author Wojtyniak, Bogdan author Wong, Tien Yin author Woo, Jean author Woodward, Mark author Wu, Aleksander Giwercman author Wu, Frederick C author Wu, Shou Ling author Xu, Haiquan author Yang, Xiaoguang author Ye, Xingwang author Yoshihara, Akihiro author Younger-Coleman, Novie O author Zambon, Sabina author Zargar, Abdul Hamid author Zdrojewski, Tomasz author Zhao, Wenhua author Zheng, Yingfeng author 2015-08 Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. Danaei G, Fahimi S, Lu Y, Zhou B, Hajifathalian K, Di Cesare M, et al. Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331288 participants. Lancet Diabetes Endocrinol. 2015 Aug;3(8):624-37. Epub 2015 Jun 21. 10.1016/S2213-8587(15)00129-1 2213-8595 2213-8587 Lancet Diabetes & Endocrinology http://hdl.handle.net/20.500.13003/10772 26109024 L604933145 2-s2.0-84938199196 http://hdl.handle.net/20.500.12105/20129 358540100018 Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331288 participants