Authors: C Sabanayagam G Liew E S Tai A Shankar S C Lim T Subramaniam T Y Wong
Publish Date: 2009/04/22
Volume: 52, Issue: 7, Pages: 1279-
Abstract
We examined a populationbased sample of 3190 Malay adults aged 40–80 years in Singapore The microvascular outcomes of interest were 1 any retinopathy defined from fundus photographs 2 mild retinopathy defined as in 1 3 moderate retinopathy defined as in 1 4 chronic kidney disease defined from estimated glomerular filtration rate 5 micro or macroalbuminuria defined from urinary albumin to creatinine ratio and 6 peripheral neuropathy defined from neurothesiometer or monofilament sensory testingIncreasing HbA1c was associated with all microvascular complications The optimal cutoff points for detecting mild and moderate retinopathy were 66 870 sensitivity 771 specificity and area under the receiver operating characteristics ROC curve 0899 and 70 829 sensitivity 823 specificity and area under ROC curve 0904 The prevalences of mild and moderate retinopathy were 1 below the optimal cutoff points For other complications the association with HbA1c was linear without evidence of a distinct threshold Although ROC analysis for these other complications also suggested optimal cutoff points between 66 and 70 the sensitivity at these cutoff points was considerably lower than for mild and moderate retinopathy ranging from 318 to 665Higher levels of HbA1c were associated with microvascular complications Our data support use of an HbA1c cutoff point of between 66 and 70 in diagnosing diabetes Cutoff points in this range were best for the identification of individuals with mild and moderate retinopathy Any retinopathy chronic kidney disease albuminuria and peripheral neuropathy are less well detected at these cutoff points
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