Evidence map›Paper›PMID 34535465›Full record

Observational studyBMJ open diabetes research & care2021

HbA1c performs well in monitoring glucose control even in populations with high prevalence of medical conditions that may alter its reliability: the OPTIMAL observational multicenter study.

Anxious J Niwaha, Lauren R Rodgers, Rosamund Greiner, Priscilla A Balungi, Raymond Mwebaze, Timothy J McDonald, Andrew T Hattersley, Beverley M Shields, Moffat J Nyirenda, Angus G Jones

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open diabetes research & care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Anxious J NiwahaInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.ORCID 0000-0003-0939-9380
Lauren R RodgersInstitute of Health Research, University of Exeter Medical School, Exeter, UK.
Rosamund GreinerInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.
Priscilla A BalungiInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.
Raymond MwebazeDepartment of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda.
Timothy J McDonaldInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.ORCID 0000-0003-3559-6660
Andrew T HattersleyInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.ORCID 0000-0001-5620-473X
Beverley M ShieldsInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.ORCID 0000-0003-3785-327X
Moffat J NyirendaNCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
Angus G JonesInstitute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK Angus.Jones@exeter.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden. RESEARCH DESIGN AND

methodsWe assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability.

results32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%.

conclusionsHbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available.

Indexed as

Blood GlucoseDiabetes Mellitus, Type 2Blood Glucose Self-MonitoringGlycated HemoglobinHumansPrevalenceReproducibility of ResultsBlood GlucoseGlycated HemoglobinCGMdiabetes mellitusHbA1cmonitoringtype 2

Identifiers

PMID34535465
PMCPMC8451306

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.