Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion

Diabet Med. 2013 Jul;30(7):825-8. doi: 10.1111/dme.12161. Epub 2013 Mar 23.


Aim: The prevalence of diabetes mellitus among Malaysians aged ≥ 30 years of age has increased by more than twofold over a 20-year period. This study aimed to determine the current status and to evaluate the diagnostic usefulness of the HbA(1c) cut-off point of 48 mmol/mol (6.5%).

Methods: Using a two-stage stratified sampling design, participants aged ≥ 18 years were recruited from five zones selected to represent Malaysia. An oral glucose tolerance test was performed on all those not known to have diabetes.

Results: A total of 4341 subjects were recruited. By World Health Organization criteria, the prevalence of diabetes mellitus was 22.9%; of that percentage, 10.8% was known diabetes and 12.1% was newly diagnosed diabetes. Diabetes was most prevalent amongst Indians (37.9%) and Malays (23.8%). Prevalence of new diabetes mellitus was only 5.5% (95% CI 4.9-6.3) when based on the HbA(1c) diagnostic criteria of 48 mmol/mol (6.5%) and, although the cut-off point was highly specific (98.1%), it was less sensitive (36.7%) compared with 45 mmol/mol (6.3%), which showed the optimal sum of sensitivity (42.5%) and specificity (97.4%) in identifying new diabetes mellitus.

Conclusion: This study recorded an overall diabetes prevalence of 22.6%, almost a twofold increase from 11.6% reported in 2006. This was likely attributable to the higher prevalence of new diabetes (12.1%) diagnosed following an oral glucose tolerance test. An HbA(1c) of 45 mmol/mol (6.3%) was found to be a better predictive cut-off point for detecting new diabetes in our multi-ethnic population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • China / ethnology
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / epidemiology*
  • Ethnic Groups
  • Female
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / analysis
  • Humans
  • India / ethnology
  • Malaysia / epidemiology
  • Male
  • Middle Aged
  • ROC Curve
  • Reference Values
  • Sensitivity and Specificity
  • World Health Organization


  • Glycated Hemoglobin A