Article Text

Ethnic differences in prevalence of actionable HbA1c levels in UK Biobank: implications for screening
  1. Jana J Anderson1,
  2. Paul Welsh2,
  3. Frederick K Ho1,
  4. Lyn D Ferguson2,
  5. Claire E Welsh3,
  6. Pierpaolo Pellicori1,
  7. John G F Cleland1,
  8. John Forbes4,
  9. Stamatina Iliodromiti1,5,
  10. James Boyle2,
  11. Robert Lindsay2,
  12. Carlos Celis-Morales2,
  13. Stuart Robert Gray2,
  14. Srinivasa Vittal Katikireddi1,
  15. Jason Martin Regnald Gill2,
  16. Jill P Pell1,
  17. Naveed Sattar2
  1. 1Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  3. 3Population and Health Sciences, Newcastle University, Newcastle upon Tyne, UK
  4. 4Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
  5. 5Centre of Women’s Health, Yvonne Carter Building, Queen Mary University of London, London, UK
  1. Correspondence to Professor Naveed Sattar; Naveed.Sattar{at}; Dr Jana J Anderson; Jana.Anderson{at}


Introduction Early detection and treatment of diabetes as well as its prevention help lessen longer-term complications. We determined the prevalence of pre-diabetes and undiagnosed diabetes in the UK Biobank and standardized the results to the UK general population.

Research design and methods This cross-sectional study analyzed baseline UK Biobank data on plasma glycated hemoglobin (HbA1c) to compare the prevalence of pre-diabetes and undiagnosed diabetes mellitus in white, South Asian, black, and Chinese participants. The overall and ethnic-specific results were standardized to the UK general population aged 40–70 years of age.

Results Within the UK Biobank, the overall crude prevalence was 3.6% for pre-diabetes, 0.8% for undiagnosed diabetes, and 4.4% for either. Following standardization to the UK general population, the results were similar at 3.8%, 0.8%, and 4.7%, respectively. Crude prevalence was much higher in South Asian (11.0% pre-diabetes; 3.6% undiagnosed diabetes; 14.6% either) or black (13.8% pre-diabetes; 3.0% undiagnosed diabetes; 16.8% either) participants. Only six middle-aged or old-aged South Asian individuals or seven black would need to be tested to identify an HbA1c result that merits action.

Conclusions Single-stage population screening for pre-diabetes or undiagnosed diabetes in middle-old or old-aged South Asian and black individuals using HbA1c could be efficient and should be considered.

  • diabetes mellitus
  • type 2
  • early diagnosis
  • glycated hemoglobin A
  • ethnic groups

Data availability statement

Data may be obtained from a third party and are not publicly available. UK Biobank data can be requested by bona fide researchers for approved projects, including replication, through

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data may be obtained from a third party and are not publicly available. UK Biobank data can be requested by bona fide researchers for approved projects, including replication, through

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  • Contributors JJA, JPP, and NS conceived the idea, with useful methodological discussions among all authors. JJA analyzed the data. JJA, JPP, and NS cowrote the first draft. All other authors contributed to discussions and reviewed/edited the manuscript. NS is the guarantor of this work and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work was supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217). SVK acknowledges funding from the Medical Research Council (MC_UU_12017/13), the Scottish Government Chief Scientist Office (SPHSU13), and an NRS Senior Clinical Fellowship (SCAF/15/02).

  • Competing interests NS reports grant and personal fees from Boehringer Ingelheim, and personal fees from Amgen, AstraZeneca, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi, outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.