The prevalence and correlates of pre-diabetes in middle- to older-aged Irish adults using three diagnostic methods.
Level 4 - case-series / case-control
Cross-sectional epidemiological analysis of a primary care cohort
PubMed 34170932 · doi:10.1371/journal.pone.0253537
What was done
A cross-sectional follow-up study (Mitchelstown Cohort Rescreen, 2016/17) evaluated 1,378 middle- to older-aged adults recruited from a single primary care center in Ireland. Pre-diabetes was defined using three criteria: ADA HbA1c (5.7%–6.4%), WHO-IEC HbA1c (6.0%–6.4%), and ADA fasting plasma glucose (FPG; 5.6–6.9 mmol/l). Univariate and multivariable logistic regression were used to identify correlates.
What was found
Pre-diabetes prevalence was 43.9% (95% CI: 41.2%–46.5%) by ADA HbA1c, 14.5% (95% CI: 12.7%–16.5%) by WHO-IEC HbA1c, and 15.8% (95% CI: 13.9%–17.8%) by ADA FPG. Univariate associations included sex, age, marital status, health rating, education, and poor diet quality. In multivariable analysis, subjects identified by ADA FPG had the least favorable metabolic profiles, correlating with overweight/obesity (OR = 2.88, 95% CI: 1.53–5.43), hypertension (OR = 2.27, 95% CI: 1.51–3.40), and low HDL cholesterol (OR = 1.75, 95% CI: 1.07–2.87).
Why it matters
Diagnostic definitions cause a threefold variation in pre-diabetes prevalence estimates, significantly impacting screening benchmarks and resource planning for national prevention programs.
Limits
The sample was derived from a single primary care center, limiting broader generalizability. The cross-sectional design cannot determine progression rates to type 2 diabetes or long-term clinical outcomes.
Cited by
- supports A hemoglobin A1c of 5.7% is the diagnostic threshold for prediabetes.