Optimal screening tool for prediabetes and undiagnosed diabetes using waist circumstance and waist-to-height ratio

Objective To investigate and compare the optimal screening tool for impaired fasting glucose(IFG) subjects, impaired glucose tolerance(IGT) subjects and undiagnosed diabetes, using waist circumstance(WC) and waist-to-height ratio(WHtR) in Shanghai. Methods A total of 18 062 participants (aged ≥35 years) were enrolled from the Shanghai Chronic Disease and Risk Factor Surveillance in 2013. Correlational analyses of WC and WHtR with IFG and IGT were conducted using Pearson correlation method. The receiver operating characteristic (ROC) analysis was used to compare their predictive ability for IFG, IGT and undiagnosed diabetes. According to the recommended cut-off value, screening of the three abnormal glucose status was performed using WC, WHtR and/or body mass index (BMI). Results Both WC and WHtR were positively correlated with FPG (r=0.161, 0.153, P 0.05). The difference of the best cut-off value of WC and WHtR between male and female subjects was 3-5 cm and 0.01, respectively. Among 4 screening algorithms by combining BMI in parallel or in serial, the specificity of WC combing BMI in serial was the highest for the screening of IFG, IGT, undiagnosed diabetes, and abnormal glucose subject (67.61%, 69.17%, 68.94%, and 72.46%, respectively). The sensitivity of WHtR combing BMI in parallel was the highest (76.10%, 82.79%, 83.89%, and 81.63%). Conclusion WHtR is a better option than WC in screening IGT for females. There is almost no gender difference in the optimal cut off values of WHtR for screening of IGT, IFG and undiagnosed diabetes. Key words: Diabetes mellitus; Impaired fasting glucose; Impaired glucose tolerance; Waist circumstance; Waist-to-height ratio