@article {Hodele000939, author = {Nikolai Carl Hodel and Ali Hamad and Klaus Reither and Grace Mwangoka and Irene Kasella and Claudia Praehauser and Salim Abdulla and Christoph F R Hatz and Michael Mayr}, title = {Assessment of diabetes and prediabetes prevalence and predictors by HbA1c in a population from sub-Saharan Africa with a high proportion of anemia: a prospective cross-sectional study}, volume = {8}, number = {1}, elocation-id = {e000939}, year = {2020}, doi = {10.1136/bmjdrc-2019-000939}, publisher = {BMJ Specialist Journals}, abstract = {Introduction Epidemiological data about diabetes mellitus (DM) for sub-Saharan Africa (SSA) are scarce and the utility of glycated hemoglobin (HbA1c) to diagnose DM is uncertain in African populations with a high proportion of anemia.Research design and methods In a cross-sectional study, age-adjusted prevalence rates and predictors for DM and pre-DM were prospectively assessed by HbA1c in a semirural walk-in population of Tanzania (n=992). Predictors for DM were calculated by logistic regression. Correlations between HbA1c, hemoglobin, and blood glucose levels were done by Pearson{\textquoteright}s correlation.Results Overall, DM and pre-DM prevalence rates were 6.8\% (95\% CI 5.3 to 8.5) and 25\% (95\% CI 22.8 to 28.3), respectively. There was an increase in DM prevalence in patients 50{\textendash}59 (14.9\%; 95\% CI 9.1 to 22.5), >=60 years old (18.5\%; 95\% CI 12.2 to 26.2) and in patients with overweight (9.3\%; 95\% CI 5.9 to 13.7), obesity (10.9\%; 95\% CI 6.9 to 16) compared with patients 18{\textendash}29 years old (2.2\%; 95\% CI 0.9 to 4.4) (p\<0.001) and to normal-weight patients (3.6\%; 95\% CI 2.1 to 5.6) (p\<0.01), respectively. Age (OR 1.08, 95\% CI 1.05 to 1.12; p\<0.001), body mass index (BMI) (OR 1.10, 95\% CI 1.04 to 1.16; p\<0.001), and acute infection (OR 3.46, 95\% CI 1.02 to 10.8; p=0.038) were predictors for DM. Comparing patients with a BMI of 20 kg/m2 and a BMI of 35 kg/m2, the relative risk for DM increases in average by 2.12-fold (range 1.91{\textendash}2.24) across the age groups. Comparing patients 20 years old with patients 70 years old, the relative risk for DM increases in average 9.7-fold (range 8.9{\textendash}10.4) across the BMI groups. Overall, 333 patients (36\%) suffered from anemia. Pearson{\textquoteright}s correlation coefficients (r) between HbA1c and hemoglobin was -0.009 (p=0.779), and between HbA1c and fasting blood glucose and random blood glucose, it was 0.775 and 0.622, respectively (p\<0.001).Conclusion We observed a high prevalence of DM and pre-DM, mainly triggered by increasing age and BMI, and provide evidence that HbA1c is suitable to assess DM also in populations of SSA with high proportions of anemia.Trial registration number NCT03458338.}, URL = {https://drc.bmj.com/content/8/1/e000939}, eprint = {https://drc.bmj.com/content/8/1/e000939.full.pdf}, journal = {BMJ Open Diabetes Research and Care} }