Treatment patterns and clinical characteristics of patients with type 2 diabetes mellitus according to body mass index: findings from an electronic medical records database

Trends of HbA1c and BMI in People with Type 2 Diabetes: A Japanese Claims-Based Study

INTRODUCTION

Obesity prevalence has increased in Japan in recent years. Given the strong association of obesity with poor glycemic control, and increased risk of type 2 diabetes (T2D) with central obesity, this study describes the current trends and relationships between glycated hemoglobin (HbA1c), body mass index (BMI), and waist circumference in the Japanese people with T2D.

METHODS

This was a retrospective, cross-sectional study of people with T2D who had at least one recorded HbA1c and BMI (or waist circumference) value in the Japan Medical Data Center Claims database. Five annual cohorts of the study population were formed between January 2017 and December 2021. Annual trends of HbA1c across BMI categories (obesity class I [≥ 25 ~  < 30 kg/m2]-IV [≥ 40 kg/m2]) and in people with central obesity (waist circumference: ≥ 85 cm in men; ≥ 90 cm in women) were described by sex and age groups.

RESULTS

Overall, 106,089 people with T2D (HbA1c and BMI data: 106,079; HbA1c and waist circumference data: 105,424) were included, with the majority of people belonging to obesity class I (range: 39.7-40.6%) and obesity class II (range: 16.2-17.7%) categories across all annual cohorts. People in higher BMI categories had higher mean HbA1c, with > 50% of people with T2D in obesity class I-IV (54.8-56.5%) having HbA1c ≥ 7%. Between 2017 and 2021, BMI and waist circumference increased in the age group 18-44 years. More than 50% of people with T2D and central obesity in both sexes and people of age group 18-44 years across obesity class I-IV or with central obesity had HbA1c ≥ 7%.

CONCLUSION

More than half of the people with T2D belonging to obesity class I-IV or central obesity had poor glycemic control (HbA1c ≥ 7%), especially in the 18-44 age group. This highlights the need for body weight management for better glycemic control in relatively young Japanese people with T2D and obesity.

The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores

PURPOSE

This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management.

METHODS

The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R.

RESULTS

The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management.

CONCLUSION

It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study

Introduction

Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes.

Materials and methods

We conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was <0.05.

Results

The study results showed that health literacy, HbA1c, and income were main predictors of diabetes treatment adherence. The patients' adherence increased as their health literacy increased. The patients' HbA1c decreases as their adherence increased. We found a 2.54-point increase in the treatment adherence score for those with sufficient income and a 0.76-point increase in the treatment adherence score for those with relatively sufficient income compared with those with insufficient income.

Conclusion

We found several factors affecting diabetes treatment adherence. Planning theory-based interventions can be helpful to improve the determinants.

Prevalence of Obesity and Cardiovascular Risk Factors Among Type 2 Diabetes Mellitus Patients in Al-Khobar, Saudi Arabia

BACKGROUND

The prevalence of obesity has grown significantly worldwide. It is considered a major cardiovascular risk factor among type II diabetes mellitus (T2DM) patients.

OBJECTIVES

The main objective of this study is to determine the prevalence of obesity in patients with T2DM at King Fahd University Hospital (KFUH), Al-Khobar, and to assess the relationship between T2DM and cardiovascular risk factors with body mass index (BMI) and waist to hip ratio (WHR).

METHODS

A retrospective, cross-sectional study, included T2DM patients from the Internal Medicine department at KFHU. The investigators recorded patient demographics (age and gender), weight (kg), height (cm), body mass index (Kg/m²), waist and hip circumference (cm), smoking status, physical activity, blood pressure measurements (mmHg) and laboratory results of fasting blood glucose (FBG), glycated haemoglobin (HbA1c) and lipid profile.

RESULTS

Among 346 patients, the prevalence of obesity and overweight was 62.4% and 27.2%, respectively. The relationship between BMI and demographic data including age and gender was statistically significant (P<0.05). The correlation between the BMI with cardiovascular risk factors including smoking, physical activity and WHR found to be statistically significant (P<0.05).

CONCLUSION

Our study showed that obesity and overweight affect 89.6% of patients with T2DM. Therefore, it is important to take into consideration weight control strategies to effectively manage diabetic patients.

Impact of Partial Meal Replacement on Glycemic Levels and Body Weight in Indian Patients with Type 2 Diabetes (PRIDE): A Randomized Controlled Study

INTRODUCTION

Partial meal replacement (PMR) offers potential glycemic and weight control benefits in type 2 diabetes mellitus (T2DM) patients. We evaluated the clinical impact of PMR (diabetes-specific nutritional supplement [DSNS]) in overweight/obese Indian patients with T2DM.

METHODS

PRIDE, a 12-week, phase IV, open-label, multicenter study randomized (1:1) newly diagnosed T2DM patients (≤ 1 year) to either DSNS plus standard of care (SOC; diabetes treatment with dietary counseling) group (PMR) or SOC alone group (SOC). The primary endpoint was mean change in glycated hemoglobin (HbA1c) from baseline to week 12. Secondary endpoints were changes in glucose profiles, body weight, waist circumference, lipid profile, and factors impacting quality-of-life (QoL) at week 6 and 12 from baseline. Safety was assessed throughout the study.

RESULTS

Of the 176 patients enrolled, 171 (n = 85 in PMR group; n = 86 in SOC group) were included in the modified intent-to-treat population. The mean reduction in HbA1c at week 12 from baseline in PMR group was significant compared to the SOC group (- 0.59 vs. - 0.21%, p = 0.002). At week 12, the PMR group showed significant reduction in mean body weight (- 2.19 vs. - 0.22 kg; p = 0.001) and waist circumference (- 2.34 vs. - 0.48 cm; p = 0.001) compared to SOC group. Mean fasting plasma glucose and post-prandial glucose significantly reduced from baseline at week 6 and 12 in each group (p < 0.05). No significant change was observed in lipid profile. QoL parameters (treatment adherence, general well-being, and energy fulfilment) in the PMR were significantly better than SOC group (p < 0.05). Patients were satisfied with the taste of DSNS. No serious adverse events were reported.

CONCLUSIONS

DSNS is an encouraging option for PMR strategy, as it significantly improved HbA1c, body weight, waist circumference, and overall well-being among overweight/obese Indian T2DM patients.

TRIAL IDENTIFICATION NO

CTRI/2019/10/021595.

Efficacy and safety of oral semaglutide by subgroups of patient characteristics in the PIONEER phase 3 programme

AIMS

To evaluate the efficacy and safety of oral semaglutide versus comparators by patient characteristic subgroups in patients with type 2 diabetes.

MATERIALS AND METHODS

Change from baseline in glycated haemoglobin (HbA1c) and body weight, and achievement of HbA1c <7.0% with oral semaglutide 7 mg, oral semaglutide 14 mg, flexibly dosed oral semaglutide (flex) and comparators were assessed across baseline subgroups (age, race, ethnicity, diabetes duration, body mass index and HbA1c) from the PIONEER programme. Treatment differences were analysed using a mixed model for repeated measurements for continuous variables and a logistic regression model for the binary endpoint. Pooled safety data were analysed descriptively.

RESULTS

Changes from baseline in HbA1c and body weight, and the odds of achieving HbA1c <7.0%, were greater with oral semaglutide 14 mg/flex (n = 1934) and higher or similar with oral semaglutide 7 mg (n = 823) versus comparators (n = 2077) across most subgroups. Changes in HbA1c with oral semaglutide 14 mg/flex were greater for patients with higher baseline HbA1c (HbA1c >9.0%: -1.7% to -2.6%; HbA1c <8.0%: -0.7% to -1.2%). In some trials, Asian patients experienced greater HbA1c reductions with oral semaglutide 14 mg/flex (-1.5% to -1.8%) than other racial groups (-0.6% to -1.6%). The overall incidence of adverse events (AEs) with oral semaglutide was similar to that with comparators and was consistent across subgroups. More gastrointestinal AEs were observed with oral semaglutide, versus comparators, across subgroups.

CONCLUSIONS

Oral semaglutide demonstrated consistently greater HbA1c and body weight reductions across a range of patient characteristics, with greater HbA1c reductions seen at higher baseline HbA1c levels.

Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review

PURPOSE

Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation.

METHODS

Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD).

RESULTS

Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug's weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type.

CONCLUSION

Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual's treatment, weight journey, and behaviors over time should be undertaken.

Obesity and glycemic control among people with type 2 diabetes in the United States: A retrospective cohort study using insurance claims data

AIMS

To examine body mass index (BMI) and HbA1c for individuals with type 2 diabetes (T2D) in the United States.

METHODS

The retrospective study utilized data from IBM® MarketScan® Explorys® Claims-EMR Data for the years 2012-2019. Individuals with T2D and a recorded HbA1c laboratory result and BMI were included. The relationship between BMI and HbA1c was assessed descriptively and logistic regressions examined the relationship between benchmark BMI and the probability of having HbA1c above targets of 7% or 8% in the 1year post-period.

RESULTS

In our sample of 44,723 patients, results indicated that compared to individuals of normal weight, those classified as obese class I or obese class II were 24% more likely to have a last HbA1c≥7% (Odds Ratio [OR]=1.24; 95% Confidence Interval [CI] 1.14-1.35 for both obese class I and obese class II), while those classified as obese class III were 16% more likely (OR=1.16; 95% CI 1.06-1.27). Results were similar when using a HbA1c threshold of 8%.

CONCLUSIONS

Given the importance of glycemic control for people with T2D, these results suggest that treatments which reduce rates of obesity may help to improve health outcomes.

Trends in HbA1c and Body Mass Index Among Individuals with Type 2 Diabetes: Evidence from a US Database 2012-2019

INTRODUCTION

Given the high rates of obesity and poor glycemic control among individuals with type 2 diabetes (T2D), this study examines current trends in HbA1c and body mass index (BMI) as well as the association between HbA1c and BMI among adults with T2D.

METHODS

Data from the IBM® MarketScan® Explorys® Claims-EMR Data were used to construct eight annual cohorts for the years 2012-2019. Each annual cohort included adults identified with T2D who had at least one recorded HbA1c laboratory result and BMI value in the year of interest. Given these cohorts, trends in HbA1c and BMI were described over time using generalized estimating equation (GEE) tests.

RESULTS

Results indicate that, over the study period from 2012-2019, average BMI increased significantly and there was a decrease in the percentage of adults with T2D who achieved glycemic control. In addition, for all years, higher BMI classification was associated with higher HbA1c values. When examining results for patients in different age groups, the findings were generally consistent with the overall population. In each age group, but most notably the age 18-44 group, the mean BMI increased over time and higher BMI was associated with higher HbA1c.

CONCLUSION

Given the increase in BMI and decreasing percentage of individuals achieving glycemic control among adults with T2D found over the study period, therapies which decrease BMI as well as HbA1c can potentially have a significant impact on the management of T2D. The growing proportion of the younger age group with higher mean BMI may remain a key subgroup of interest.

Healthcare outcomes for patients with type 2 diabetes with and without comorbid obesity

AIMS

Examine the burden of comorbid obesity associated with type 2 diabetes (T2D).

METHODS

The IBM® MarketScan® Explorys Claims Electronic Medical Records Data were used to identify adults with T2D, two recorded body mass index (BMI) values, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index BMI ≥18 kg/m² and <30 kg/m² (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m² (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, healthcare costs, and resource utilization.

RESULTS

In the matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.29; 95% Confidence Interval [CI] 1.21-1.38) and an obesity-related comorbidity (OR = 1.42; 95% CI 1.29-1.56). Obesity was also associated with significantly higher annual diabetes-related and all-cause total costs and resource utilization.

CONCLUSIONS

This research increases the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.

Regional differences in the management of cardiovascular risk factors among adults with diabetes: An evaluation of the Diabetes Collaborative Registry

AIMS

To compare cardiovascular risk factor control in adults with diabetes participating in a national diabetes registry to those in the general population and to ascertain regional differences in diabetes care.

METHODS

Adults with diagnosed diabetes in the Diabetes Collaborative Registry (DCR) were compared with those in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016; standardized mean difference (SMD) > 0.2 defined significance. Regional differences were assessed in the DCR cohort; p < .05 defined significance.

RESULTS

The DCR cohort was older (61 vs. 57 years, SMD = 0.38), more insured (99.7% vs. 91.0%, SMD = 0.42), and less ethnically diverse (83% non-Hispanic white vs. 76%, SMD = 0.30) compared with NHANES. The proportion of overweight/obesity, A1c < 7% (<53 mmol/mol), and BP < 140/90 were similar, but DCR participants had higher proportion with LDL < 2.59 mmol/L (61% vs. 41%, SMD = 0.39) and fewer tobacco users (17% vs. 32%, SMD = 0.35). Regionally, obesity, lack of glycaemic control, and tobacco use were highest in the Midwest, BP control was the lowest in the South, and LDL control was lowest in the Northeast.

CONCLUSIONS

Significant regional differences in diabetes care delivery and outcomes were identified using a national diabetes registry. Serial analyses of the DCR may supplement national evaluations to deepen our understanding of diabetes care in the US.

Anti-atherosclerotic effects between a combined treatment with simvastatin plus hirudin and single simvastatin therapy in patients with early type 2 diabetes mellitus

Background

This study aimed to investigate the efficacy and safety of simvastatin plus hirudin in preventing atherosclerosis in the patients with early type 2 diabetes mellitus (T2DM).

Methods

This was a 24-week, randomized, open-label and controlled study in which 150 outpatients initially diagnosed with T2DM were randomly assigned into either simvastatin (40 mg daily at night) plus hirudin (3 g thrice daily) group [combined group (CG) n=75] or simvastatin (40 mg once daily) group [monotherapy group (MG) n=75]. The therapeutic efficacy was evaluated by the score of carotid artery atherosclerosis, plaque size, peak systolic velocity (PSV) and end-diastolic velocity (EDV) on carotid ultrasonography at three and six months after treatment. Logistic regression analysis was used to investigate the correlation between treatment and carotid atherosclerosis.

Results

One hundred and thirty-one patients completed this study, and there were no significant differences in the dropout rate in the CG (14.67%) and the MG (10.67%). Significant difference was found in the incidence of adverse events in the CG compared with the MG (37.50% vs. 17.91%, P<0.05) due to the higher risk of hemorrhage (12.50% vs. 1.49%, P<0.05), which did not affect the treatment compliance. The efficacy of combined treatment was better than monotherapy in the enhancement of carotid artery atherosclerosis scores (P<0.01), the plaque thickness (P<0.05) and the change of PSV (P<0.05) and EDV (P<0.05) since three months after treatment, which maintained to the end of observation. In addition, hirudin treatment was able to independently predict the carotid artery atherosclerosis scores (β=2.37, P<0.05), the plaque thickening (β=3.51, P<0.01) and the change of PSV (β=1.69, P<0.05) and EDV (β=1.79, P<0.05).

Conclusions

Combined use of simvastatin and hirudin is well tolerated and possesses better anti-atherosclerotic effects than simvastatin alone in patients with early T2DM.

Body mass index and insulin use as identifiers of high-cost patients with type 2 diabetes: A retrospective analysis of electronic health records linked to insurance claims data

AIMS

To study the association of body mass index (BMI) and insulin use with type 2 diabetes-related healthcare expenditures (T2D-HE).

MATERIALS AND METHODS

Retrospective study using de-identified electronic health records linked to insurance claims data. Study included a prevalence-based sample of overweight or obese patients with antihyperglycaemic-treated T2D. Patients had ≥1 A1c measurement in 2014 (last observed = index A1c), ≥1 BMI measurement within ±90 days of index (average BMI = baseline BMI), and continuous enrolment for 180 days before (baseline) through 395 days after index (day 30-395 = follow-up). BMI was categorized as: 25 to 29.9 kg/m² = overweight; 30 to 34.9 kg/m² = obese class I (OCI); 35 to 39.9 kg/m² = OCII; ≥40 kg/m² = OCIII. Multivariable regressions were used to examine one-year follow-up T2D-HE as a function of BMI, insulin use, an interaction term between BMI and insulin use, and patient demographics.

RESULTS

Study included 13 026 patients (mean age = 63.6 years; 48.1% female; 29.5% overweight, 31.6% OCI, 20.3% OCII, 18.6% OCIII; 25.3% insulin users). Baseline insulin use rates monotonically ranged from 19.7% in overweight patients to 33.0% in OCIII patients (P < 0.001). Together, BMI and insulin use were jointly associated with one-year follow-up T2D-HE, which monotonically ranged from $5842 in overweight patients with no insulin to $17 700 OCIII insulin users, P < 0.001. Within each BMI category, insulin users' one-year T2D-HE was at least double that of non-users. Additional analyses of all-cause healthcare expenditures yielded consistent results.

CONCLUSIONS

BMI and insulin use represent simple stratifiers for identifying high-cost patients. OCIII insulin users incurred the greatest annual healthcare expenditures; these patients may be an ideal group for targeted interventions.

Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia

OBJECTIVE

Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients' interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0.

RESULTS

Participants' mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required.

Prevalence of diabetes, use of antidiabetic drugs and degree of glycaemic control in the province of Cadiz (2014-2016): A population-based study

BACKGROUND AND OBJECTIVE

The aim of the study was to assess the prevalence of diabetes mellitus treated pharmacologically, analyse the prescription patterns of antidiabetic drugs and assess the degree of control over the disease in the province of Cadiz.

PATIENTS AND METHODS

An observational retrospective study was conducted with the databases of the public health system of the Andalusian Health Service between 2014 and 2016, inclusive. Adults with treated diabetes (ATD) were considered those older than 14 years who had consumed at least 1 package of medication from the A10 group during the corresponding year covered by the study.

RESULTS

The prevalence of ATD varied between 8.65% and 8.83% from 2014 to 2016, respectively. Seventy-one percent of the ATD were treated with only noninsulin drugs, 11% were treated with insulin, and 18% were treated with a combination of both. For approximately one-third of the ATD, an HbA1c reading was not performed during each year. Sixty-nine percent of the assessed ATD in 2016 had an appropriate degree of control according to RedGDPS criteria (based on HbA1c and age).

CONCLUSION

The prevalence of pharmacologically treated diabetes in the province of Cadiz is high and appears to be increasing. The patients presented limited glycaemic control, to which inadequate follow-up in almost a third of the patients could be the major contributor.

Use of point-of-care HbA1c measurement to estimate the level of undiagnosed diabetes mellitus among 67-year-old participants in a cardiovascular screening programme in the municipality of Viborg, Denmark

AIMS

To determine the prevalence of unidentified diabetes mellitus among 67-year-olds in Denmark participating in a screening programme focusing on cardiovascular disease and diabetes, and to describe glycaemic levels in individuals according to point-of-care HbA1c combined with self-reported diabetes status.

METHODS

In this cross-sectional, retrospective, population-based study, all people aged 67 years living in the Viborg municipality were invited to take part in the Viborg Inter-sectorial Screening Programme (VISP), which focuses on cardiovascular disease and diabetes. The VISP study was initiated in August 2014 and is ongoing. During the first 2 years of the programme, we stratified participants into groups based on their self-reported diabetes status and a single HbA1c measurement.

RESULTS

A total of 1802 individuals were invited to participate, and 1501 consented, seven of whom were excluded because of missing data (HbA1c or diabetes status), resulting in an 82.9% participation rate (n=1494). Among those reporting not to have diabetes, 3.3% (n=45) had an HbA1c level ≥48 mmol/mol (6.5%). In the same group, 16.7% (n=226) had an HbA1c level of 41-48 mmol/mol (5.9-6.5%). Among those self-reporting the presence of diabetes, 30.1% (n=43) had an HbA1c level ≥58 mmol/mol (7.5%).

CONCLUSIONS

The prevalence of unidentified diabetes was 3.3% based on a single HbA1c measurement. Furthermore, 16.7% of those reporting not to have diabetes had an HbA1c level of 41-48 mmol/mol (5.9-6.5%), representing a subgroup with an increased risk of developing diabetes. Among those with self-reported diabetes, 30.1% had an HbA1c level ≥58 mmol/mol (7.5%) and 6.3% had a level >74 mmol/mol (8.9%).