Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2024; 15(7): 1531-1536
Published online Jul 15, 2024. doi: 10.4239/wjd.v15.i7.1531
Cut-off value of glycated hemoglobin A1c for detecting diabetic retinopathy in the Chinese population
Yan Wen, Qing Wang
Yan Wen, Qing Wang, Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Wen Y made significant contributions in the acquisition of data or in the analysis and interpretation of data; Wang Q was responsible for the overall conception of the manuscript and revised the important parts of the manuscript; and all the authors read and approved the final manuscript.
Supported by National Key R&D Program of China, No. 2016YFC1305700.
Institutional review board statement: All experimental protocols were approved by Ethics Committee of China-Japan Union Hospital of Jilin University (Approval No. 2023093021).
Informed consent statement: Informed consent was obtained from all participants and/or their legal guardian(s).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing Wang, PhD, Chief Physician, Professor, Department of Endocrinology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, Jilin Province, China. wang_qing@jlu.edu.cn
Received: December 22, 2023
Revised: April 25, 2024
Accepted: May 23, 2024
Published online: July 15, 2024
Processing time: 199 Days and 0.9 Hours
Abstract
BACKGROUND

Glycated hemoglobin A1c (HbA1c) is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience. However, the effect of HbA1c on diabetic retinopathy (DR) in the Han and Korean populations in Jilin, China, remains inconclusive.

AIM

To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.

METHODS

This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province, China. Trained investigators employed a questionnaire-based survey, physical examination, laboratory tests, and fundus photography for the investigation. The best cut-off value for HbA1c was established via the receiver operating characteristic curve. The factors associated with HbA1c-associated risk factors were determined via linear regression.

RESULTS

The analysis included 887 eligible Chinese Han and Korean participants, 591 of whom were assigned randomly to the training set and 296 to the validation set. The prevalence of DR was 3.27% in the total population. HbA1c of 6.2% was the best cut-off value in the training set, while it was 5.9% in the validation set. In both Chinese Han and Korean populations, an HbA1c level of 6.2% was the best cut-off value. The optimal cut-off values of fasting blood glucose (FBG) ≥ 7 mmol/L and < 7 mmol/L were 8.1% and 6.2% respectively in Han populations, while those in Korean populations were 6.9% and 5.3%, respectively. Age, body mass index, and FBG were determined as the risk factors impacting HbA1c levels.

CONCLUSION

HbA1c may serve as a useful diagnostic indicator for DR. An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.

Keywords: Diabetic retinopathy; Glycated hemoglobin A1c; Cut-off value; Age; Body mass index; Fasting blood glucose

Core Tip: This cross-sectional analysis of data from 887 participants in Yanbian area of China from March to April 2017 determined the best glycated hemoglobin A1c (HbA1c) cut-off point for the diagnosis of diabetic retinopathy (DR) among the Chinese population. This study implies that HbA1c is a practical diagnostic marker for DR, and an HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.