Objective:

To systematically compare the diagnostic performance of 1-h PG, glycated albumin (GA), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and the combined HbA1c-or-FPG strategy for identifying type 2 diabetes mellitus (T2DM).

Approach:

• Data Sources: Systematic search of PubMed, Embase, Web of Science, Cochrane Library, Scopus, and gray literature.
• Inclusion Criteria: Studies evaluating diagnostic accuracy of 1-h PG, GA, FPG ≥126 mg/dL, HbA1c ≥6.5%, and combined HbA1c-or-FPG strategy, using 2-h PG ≥200 mg/dL during OGTT as the reference standard.
• Statistical Analysis: Data extraction and quality assessment by two independent reviewers; statistical analyses conducted using Stan package in R and Stata 14.0.

Key Findings:

• Pooled sensitivity: 1-h PG (0.87 [95% CrI, 0.82–0.91]), GA (0.53 [95% CrI, 0.36–0.71]), FPG (0.51 [95% CrI, 0.47–0.55]), HbA1c (0.53 [95% CrI, 0.47–0.58]), combined HbA1c-or-FPG (0.64 [95% CrI, 0.54–0.73]).
• Pooled specificity: 1-h PG (0.88 [95% CrI, 0.82–0.92]), GA (0.86 [95% CrI, 0.71–0.95]), FPG (0.96 [95% CrI, 0.95–0.97]), HbA1c (0.92 [95% CrI, 0.89–0.94]), combined HbA1c-or-FPG (0.89 [95% CrI, 0.81–0.95]).
• Pooled positive likelihood ratios (LR+): 1-h PG (7.68 [95% CrI, 4.97–11.28]), GA (4.39 [95% CrI, 1.86–9.30]), FPG (12.63 [95% CrI, 9.33–16.01]), HbA1c (6.75 [95% CrI, 4.81–9.05]), combined strategy (6.28 [95% CrI, 3.25–11.26]).
• Pooled negative likelihood ratios (LR−): 1-h PG (0.15 [95% CrI, 0.11–0.20]), GA (0.55 [95% CrI, 0.36–0.74]), FPG (0.51 [95% CrI, 0.47–0.55]), HbA1c (0.52 [95% CrI, 0.46–0.57]), combined strategy (0.41 [95% CrI, 0.31–0.53]).
• Pooled diagnostic odds ratios (DORs): 1-h PG (52.44 [95% CrI, 30.17–84.00]), GA (8.53 [95% CrI, 2.70–20.94]), FPG (24.94 [95% CrI, 17.90–32.30]), HbA1c (13.15 [95% CrI, 8.94–18.51]), combined strategy (15.83 [95% CrI, 6.62–31.47]).
• Areas under the summary receiver operating characteristic curves (SROC-AUCs): 1-h PG (0.757), GA (0.714), FPG (0.717), HbA1c (0.706), combined strategy (0.726).

Interpretation:

1-h PG demonstrated the best overall diagnostic performance for T2DM, outperforming GA, FPG, HbA1c, and the combined HbA1c-or-FPG strategy.

Limitations:

• Residual heterogeneity across studies in terms of design, population characteristics, and diagnostic thresholds.
• Findings should be interpreted with caution and confirmed by further large-scale, high-quality studies.

Conclusion:

1-h PG provides the highest sensitivity and lowest LR− among the evaluated diagnostic measures for T2DM.

Sources:

• Systematic Review Registration