J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 14, Number 1, February 2024, pages 48-58

Concordance and Associated Factors in Diagnostic Criteria for Prediabetes and Diabetes: An Analysis of Fasting Glucose, Postprandial Glucose, and Glycated Hemoglobin

**Table 1.** Characteristics of the Study Sample
Characteristics	n = 624
Data are expressed as n (%). T2DM: type 2 diabetes mellitus.
Sex
Female	316 (50.64%)
Male	308 (49.36%)
Age group
45 to 59 years	301 (48.24%)
60 years and older	323 (51.76%)
History of T2DM
No	431 (69.07%)
Yes	193 (30.93%)
Smoking activity
No	456 (73.08%)
Yes	168 (26.92%)
Alcohol consumption
No	460 (73.72%)
Yes	164 (26.28%)
Physical activity
Low	502 (80.45%)
Moderate/vigorous	122 (19.55%)
Obesity
No	388 (62.48%)
Yes	233 (37.52%)
Consumption ≥ 5 servings of fruits/vegetables
No	412 (66.03%)
Yes	212 (33.97%)
Arterial hypertension
No	471 (75.48%)
Yes	153.00 (24.52%)
Glucose status
Normal	412 (66.03%)
Prediabetes	141 (22.60%)
Diabetes	71 (11.38%)

Table 1. Characteristics of the Study Sample

Characteristics

n = 624

Data are expressed as n (%). T2DM: type 2 diabetes mellitus.

Sex

Female

316 (50.64%)

Male

308 (49.36%)

Age group

45 to 59 years

301 (48.24%)

60 years and older

323 (51.76%)

History of T2DM

431 (69.07%)

Yes

193 (30.93%)

Smoking activity

456 (73.08%)

Yes

168 (26.92%)

Alcohol consumption

460 (73.72%)

Yes

164 (26.28%)

Physical activity

Low

502 (80.45%)

Moderate/vigorous

122 (19.55%)

Obesity

388 (62.48%)

Yes

233 (37.52%)

Consumption ≥ 5 servings of fruits/vegetables

412 (66.03%)

Yes

212 (33.97%)

Arterial hypertension

471 (75.48%)

Yes

153.00 (24.52%)

Glucose status

Normal

412 (66.03%)

Prediabetes

141 (22.60%)

Diabetes

71 (11.38%)

**Table 2.** Bivariate and Multivariate Analysis of the Factors Associated With Prediabetes According to the FG, PPG and HbA1c
Characteristics	FG	PPG	HbA1c
^aEach variable has been independently adjusted for sex, age group, family history of T2DM, smoking activity, alcohol consumption, physical activity, obesity, consumption of ≥ 5 servings of fruits/vegetables, and arterial hypertension. aPR: adjusted prevalence ratio; 95% CI: 95% confidence interval; FG: fasting glucose; HbA1c: glycated hemoglobin; PPG: postprandial glucose; T2DM: type 2 diabetes mellitus.
Sex
Female	299 (96.45%)	11 (3.55%)	Ref.	-	290 (93.55%)	20 (6.45%)	Ref.	-	294 (94.84%)	16 (5.16%)	Ref.	-
Male	156 (64.20%)	87 (35.80%)	4.44	2.51 - 7.85	147 (60.49%)	96 (39.51%)	2.53	1.62 - 3.95	167 (68.72%)	76 (31.28%)	2.75	1.69 - 4.48
Age group
45 to 59 years	280 (95.56%)	13 (4.44%)	Ref.	-	266 (90.78%)	27 (9.22%)	Ref.	-	279 (95.22%)	14 (4.78%)	Ref.	-
60 years and older	175 (67.31%)	85 (32.69%)	4.28	2.56 - 7.15	171 (65.77%)	89 (34.23%)	1.98	1.38 - 2.85	182 (70.00%)	78 (30.00%)	3.11	1.91 - 5.08
History of T2DM
No	364 (86.26%)	58 (13.74%)	Ref.	-	341 (80.81%)	81 (19.19%)	Ref.	-	372 (88.15%)	50 (11.85%)	Ref.	-
Yes	91 (69.47%)	40 (30.53%)	1.55	1.11 - 2.14	96 (73.28%)	35 (26.72%)	0.77	0.57 - 1.04	89 (67.94%)	42 (32.06%)	1.66	1.23 - 2.25
Smoking activity
No	385 (86.13%)	62 (13.87%)	Ref.	-	375 (83.89%)	72 (16.11%)	Ref.	-	387 (86.58%)	60 (13.42%)	Ref.	-
Yes	70 (66.04%)	36 (33.96%)	1.40	1.03 - 1.89	62 (58.49%)	44 (41.51%)	1.28	0.95 - 1.74	74 (69.81%)	32 (30.19%)	0.99	0.66 - 1.48
Alcohol consumption
No	371 (83.75%)	72 (16.25%)	Ref.	-	365 (82.39%)	78 (17.61%)	Ref.	-	381 (86.00%)	62 (14.00%)	Ref.	-
Yes	84 (76.36%)	26 (23.64%)	1.00	0.69 - 1.44	72 (65.45%)	38 (34.55%)	1.43	1.02 - 2.00	80 (72.73%)	30 (27.27%)	1.45	0.99 - 2.11
Physical activity
Low	352 (80.55%)	85 (19.45%)	Ref.	-	337 (77.12%)	100 (22.88%)	Ref.	-	348 (79.63%)	89 (20.37%)	Ref.	-
Moderate/vigorous	103 (88.79%)	13 (11.21%)	1.10	0.72 - 1.69	100 (86.21%)	16 (13.79%)	0.95	0.62 - 1.46	113 (97.41%)	3 (2.59%)	0.23	0.08 - 0.67
Obesity
No	341 (89.74%)	39 (10.26%)	Ref.	-	344 (90.53%)	36 (9.47%)	Ref.	-	348 (91.58%)	32 (8.42%)	Ref.	-
Yes	114 (67.06%)	56 (32.94%)	1.01	0.73 - 1.41	93 (54.71%)	77 (45.29%)	1.87	1.31 - 2.68	113 (66.47%)	57 (33.53%)	1.15	0.80 - 1.65
Consumption ≥ 5 servings of fruits/vegetables
No	254 (73.41%)	92 (26.59%)	Ref.	-	235 (67.92%)	111 (32.08%)	Ref.	-	256 (73.99%)	90 (26.01%)	Ref.	-
Yes	201 (97.10%)	6 (2.90%)	0.32	0.15 - 0.68	202 (97.58%)	5 (2.42%)	0.19	0.08 - 0.46	205 (99.03%)	2 (0.97%)	0.09	0.02 - 0.37
Hypertension
No	424 (91.18%)	41 (8.82%)	Ref.	-	412 (88.60%)	53 (11.40%)	Ref.	-	425 (91.40%)	40 (8.60%)	Ref.	-
Yes	31 (35.23%)	57 (64.77%)	2.27	1.53 - 3.38	25 (28.41%)	63 (71.59%)	2.12	1.54 - 2.94	36 (40.91%)	52 (59.09%)	1.95	1.36 - 2.78

Table 2. Bivariate and Multivariate Analysis of the Factors Associated With Prediabetes According to the FG, PPG and HbA1c

Characteristics

PPG

HbA1c

No, n = 455

Yes, n = 98

aPR^a

95% CI

No, n = 437

Yes, n = 116

aPR^a

95% CI

No, n = 461

Yes, n = 92

aPR^a

95% CI

^aEach variable has been independently adjusted for sex, age group, family history of T2DM, smoking activity, alcohol consumption, physical activity, obesity, consumption of ≥ 5 servings of fruits/vegetables, and arterial hypertension. aPR: adjusted prevalence ratio; 95% CI: 95% confidence interval; FG: fasting glucose; HbA1c: glycated hemoglobin; PPG: postprandial glucose; T2DM: type 2 diabetes mellitus.

Sex

Female

299 (96.45%)

11 (3.55%)

Ref.

290 (93.55%)

20 (6.45%)

Ref.

294 (94.84%)

16 (5.16%)

Ref.

Male

156 (64.20%)

87 (35.80%)

4.44

2.51 - 7.85

147 (60.49%)

96 (39.51%)

2.53

1.62 - 3.95

167 (68.72%)

76 (31.28%)

2.75

1.69 - 4.48

Age group

45 to 59 years

280 (95.56%)

13 (4.44%)

Ref.

266 (90.78%)

27 (9.22%)

Ref.

279 (95.22%)

14 (4.78%)

Ref.

60 years and older

175 (67.31%)

85 (32.69%)

4.28

2.56 - 7.15

171 (65.77%)

89 (34.23%)

1.98

1.38 - 2.85

182 (70.00%)

78 (30.00%)

3.11

1.91 - 5.08

History of T2DM

364 (86.26%)

58 (13.74%)

Ref.

341 (80.81%)

81 (19.19%)

Ref.

372 (88.15%)

50 (11.85%)

Ref.

Yes

91 (69.47%)

40 (30.53%)

1.55

1.11 - 2.14

96 (73.28%)

35 (26.72%)

0.77

0.57 - 1.04

89 (67.94%)

42 (32.06%)

1.66

1.23 - 2.25

Smoking activity

385 (86.13%)

62 (13.87%)

Ref.

375 (83.89%)

72 (16.11%)

Ref.

387 (86.58%)

60 (13.42%)

Ref.

Yes

70 (66.04%)

36 (33.96%)

1.40

1.03 - 1.89

62 (58.49%)

44 (41.51%)

1.28

0.95 - 1.74

74 (69.81%)

32 (30.19%)

0.99

0.66 - 1.48

Alcohol consumption

371 (83.75%)

72 (16.25%)

Ref.

365 (82.39%)

78 (17.61%)

Ref.

381 (86.00%)

62 (14.00%)

Ref.

Yes

84 (76.36%)

26 (23.64%)

1.00

0.69 - 1.44

72 (65.45%)

38 (34.55%)

1.43

1.02 - 2.00

80 (72.73%)

30 (27.27%)

1.45

0.99 - 2.11

Physical activity

Low

352 (80.55%)

85 (19.45%)

Ref.

337 (77.12%)

100 (22.88%)

Ref.

348 (79.63%)

89 (20.37%)

Ref.

Moderate/vigorous

103 (88.79%)

13 (11.21%)

1.10

0.72 - 1.69

100 (86.21%)

16 (13.79%)

0.95

0.62 - 1.46

113 (97.41%)

3 (2.59%)

0.23

0.08 - 0.67

Obesity

341 (89.74%)

39 (10.26%)

Ref.

344 (90.53%)

36 (9.47%)

Ref.

348 (91.58%)

32 (8.42%)

Ref.

Yes

114 (67.06%)

56 (32.94%)

1.01

0.73 - 1.41

93 (54.71%)

77 (45.29%)

1.87

1.31 - 2.68

113 (66.47%)

57 (33.53%)

1.15

0.80 - 1.65

Consumption ≥ 5 servings of fruits/vegetables

254 (73.41%)

92 (26.59%)

Ref.

235 (67.92%)

111 (32.08%)

Ref.

256 (73.99%)

90 (26.01%)

Ref.

Yes

201 (97.10%)

6 (2.90%)

0.32

0.15 - 0.68

202 (97.58%)

5 (2.42%)

0.19

0.08 - 0.46

205 (99.03%)

2 (0.97%)

0.09

0.02 - 0.37

Hypertension

424 (91.18%)

41 (8.82%)

Ref.

412 (88.60%)

53 (11.40%)

Ref.

425 (91.40%)

40 (8.60%)

Ref.

Yes

31 (35.23%)

57 (64.77%)

2.27

1.53 - 3.38

25 (28.41%)

63 (71.59%)

2.12

1.54 - 2.94

36 (40.91%)

52 (59.09%)

1.95

1.36 - 2.78

**Table 3.** Bivariate and Multivariate Analysis of the Factors Associated With Diabetes According to the FG, PPG and HbA1c
Characteristics	FG	PPG	HbA1c
^aEach variable has been independently adjusted for sex, age group, family history of T2DM, smoking activity, alcohol consumption, physical activity, obesity, consumption of ≥ 5 servings of fruits/vegetables, and arterial hypertension. aPR: adjusted prevalence ratio; 95% CI: 95% confidence interval; FG: fasting glucose; HbA1c: glycated hemoglobin; PPG: postprandial glucose; T2DM: type 2 diabetes mellitus.
Sex
Female	314 (99.37%)	2 (0.63%)	Ref.	-	311 (98.42%)	5 (1.58%)	Ref.	-	313 (99.05%)	3 (0.95%)	Ref.	-
Male	265 (86.04%)	43 (13.96%)	4.60	1.27 - 16.7	262 (85.06%)	46 (14.94%)	2.04	0.83 - 4.99	270 (87.66%)	38 (12.34%)	2.57	0.81 - 8.09
Age group
45 to 59 years	300 (99.67%)	1 (0.33%)	Ref.	-	298 (99.00%)	3. (1.00%)	Ref.	-	296 (98.34%)	5 (1.66%)	Ref.	-
60 years and older	279 (86.38%)	44 (13.62%)	10.90	1.60 - 74.5	275 (85.14%)	48 (14.86%)	4.61	1.52 - 14.0	287 (88.85%)	36 (11.15%)	1.81	0.73 - 4.51
History of T2DM
No	427 (99.07%)	4 (0.93%)	Ref.	-	426 (98.84%)	5 (1.16%)	Ref.	-	429 (99.54%)	2 (0.46%)	Ref.	-
Yes	152 (78.76%)	41 (21.24%)	3.78	1.40 - 10.2	147 (76.17%)	46 (23.83%)	3.95	1.79 - 8.71	154 (79.79%)	39 (20.21%)	6.59	1.63 - 26.6
Smoking activity
No	453 (99.34%)	3 (0.66%)	Ref.	-	450 (98.68%)	6 (1.32%)	Ref.	-	450 (98.68%)	6 (1.32%)	Ref.	-
Yes	126 (75.00%)	42 (25.00%)	5.31	1.53 - 18.5	123 (73.21%)	45 (26.79%)	2.48	1.10 - 5.56	133 (79.17%)	35 (20.83%)	1.77	0.81 - 3.87
Alcohol consumption
No	452 (98.26%)	8 (1.74%)	Ref.	-	454 (98.70%)	6 (1.30%)	Ref.	-	457 (99.35%)	3 (0.65%)	Ref.	-
Yes	127 (77.44%)	37 (22.56%)	2.05	1.04 - 4.05	119 (72.56%)	45 (27.44%)	4.41	1.81 - 10.8	126 (76.83%)	38 (23.17%)	7.36	2.19 - 24.7
Physical activity
Low	460 (91.63%)	42 (8.37%)	Ref.	-	456 (90.84%)	46 (9.16%)	Ref.	-	463 (92.23%)	39 (7.77%)	Ref.	-
Moderate/vigorous	119 (97.54%)	3 (2.46%)	1.28	0.69 - 2.38	117 (95.90%)	5 (4.10%)	1.73	0.65 - 4.61	120 (98.36%)	2 (1.64%)	0.89	0.22 - 3.57
Obesity
No	383 (98.71%)	5 (1.29%)	Ref.	-	381 (98.20%)	7 (1.80%)	Ref.	-	384 (98.97%)	4 (1.03%)	Ref.	-
Yes	193 (82.83%)	40 (17.17%)	1.54	0.82 - 2.87	189 (81.12%)	44 (18.88%)	1.52	0.80 - 2.89	196 (84.12%)	37 (15.88%)	1.83	0.83 - 4.05
Consumption ≥ 5 servings of fruits/vegetables
No	371 (90.05%)	41 (9.95%)	Ref.	-	366 (88.83%)	46 (11.17%)	Ref.	-	374 (90.78%)	38.00 (9.22%)	Ref.	-
Yes	208 (98.11%)	4 (1.89%)	0.85	0.47 - 1.54	207 (97.64%)	5 (2.36%)	1.02	0.56 - 1.87	209 (98.58%)	3.00 (1.42%)	0.79	0.41 - 1.50
Hypertension
No	468 (99.36%)	3 (0.64%)	Ref.	-	465 (98.73%)	6 (1.27%)	Ref.	-	468 (99.36%)	3.00 (0.64%)	Ref.	-
Yes	111 (72.55%)	42 (27.45%)	4.34	1.36 - 13.9	108 (70.59%)	45 (29.41%)	3.12	1.34 - 7.25	115 (75.16%)	38.00 (24.84%)	4.38	1.18 - 16.2

Table 3. Bivariate and Multivariate Analysis of the Factors Associated With Diabetes According to the FG, PPG and HbA1c

Characteristics

PPG

HbA1c

No, n = 579

Yes, n = 45

aPR^a

95% CI

No, n = 573

Yes, n = 51

aPR^a

95% CI

No, n = 583

Yes, n = 41

aPR^a

95% CI

Sex

Female

314 (99.37%)

2 (0.63%)

Ref.

311 (98.42%)

5 (1.58%)

Ref.

313 (99.05%)

3 (0.95%)

Ref.

Male

265 (86.04%)

43 (13.96%)

4.60

1.27 - 16.7

262 (85.06%)

46 (14.94%)

2.04

0.83 - 4.99

270 (87.66%)

38 (12.34%)

2.57

0.81 - 8.09

Age group

45 to 59 years

300 (99.67%)

1 (0.33%)

Ref.

298 (99.00%)

3. (1.00%)

Ref.

296 (98.34%)

5 (1.66%)

Ref.

60 years and older

279 (86.38%)

44 (13.62%)

10.90

1.60 - 74.5

275 (85.14%)

48 (14.86%)

4.61

1.52 - 14.0

287 (88.85%)

36 (11.15%)

1.81

0.73 - 4.51

History of T2DM

427 (99.07%)

4 (0.93%)

Ref.

426 (98.84%)

5 (1.16%)

Ref.

429 (99.54%)

2 (0.46%)

Ref.

Yes

152 (78.76%)

41 (21.24%)

3.78

1.40 - 10.2

147 (76.17%)

46 (23.83%)

3.95

1.79 - 8.71

154 (79.79%)

39 (20.21%)

6.59

1.63 - 26.6

Smoking activity

453 (99.34%)

3 (0.66%)

Ref.

450 (98.68%)

6 (1.32%)

Ref.

450 (98.68%)

6 (1.32%)

Ref.

Yes

126 (75.00%)

42 (25.00%)

5.31

1.53 - 18.5

123 (73.21%)

45 (26.79%)

2.48

1.10 - 5.56

133 (79.17%)

35 (20.83%)

1.77

0.81 - 3.87

Alcohol consumption

452 (98.26%)

8 (1.74%)

Ref.

454 (98.70%)

6 (1.30%)

Ref.

457 (99.35%)

3 (0.65%)

Ref.

Yes

127 (77.44%)

37 (22.56%)

2.05

1.04 - 4.05

119 (72.56%)

45 (27.44%)

4.41

1.81 - 10.8

126 (76.83%)

38 (23.17%)

7.36

2.19 - 24.7

Physical activity

Low

460 (91.63%)

42 (8.37%)

Ref.

456 (90.84%)

46 (9.16%)

Ref.

463 (92.23%)

39 (7.77%)

Ref.

Moderate/vigorous

119 (97.54%)

3 (2.46%)

1.28

0.69 - 2.38

117 (95.90%)

5 (4.10%)

1.73

0.65 - 4.61

120 (98.36%)

2 (1.64%)

0.89

0.22 - 3.57

Obesity

383 (98.71%)

5 (1.29%)

Ref.

381 (98.20%)

7 (1.80%)

Ref.

384 (98.97%)

4 (1.03%)

Ref.

Yes

193 (82.83%)

40 (17.17%)

1.54

0.82 - 2.87

189 (81.12%)

44 (18.88%)

1.52

0.80 - 2.89

196 (84.12%)

37 (15.88%)

1.83

0.83 - 4.05

Consumption ≥ 5 servings of fruits/vegetables

371 (90.05%)

41 (9.95%)

Ref.

366 (88.83%)

46 (11.17%)

Ref.

374 (90.78%)

38.00 (9.22%)

Ref.

Yes

208 (98.11%)

4 (1.89%)

0.85

0.47 - 1.54

207 (97.64%)

5 (2.36%)

1.02

0.56 - 1.87

209 (98.58%)

3.00 (1.42%)

0.79

0.41 - 1.50

Hypertension

468 (99.36%)

3 (0.64%)

Ref.

465 (98.73%)

6 (1.27%)

Ref.

468 (99.36%)

3.00 (0.64%)

Ref.

Yes

111 (72.55%)

42 (27.45%)

4.34

1.36 - 13.9

108 (70.59%)

45 (29.41%)

3.12

1.34 - 7.25

115 (75.16%)

38.00 (24.84%)

4.38

1.18 - 16.2

**Table 4.** Concordance of Prediabetes Diagnoses Considering FG, PPG, and HbA1c
Test	Normal	Prediabetes	Total	Concordance (kappa)	Expected agreement	Agreement
FG: fasting glucose; Hb1Ac: glycosylated hemoglobin; PPG: postprandial glucose.
FG and PPG	419	36	455	0.6877	68.74%	90.24%
FG and HbA1c	427	28	455	0.6061	71.54%	88.79%
PPG and HbA1c	422	15	437	0.6812	69.37%	90.24%
Total	461	92	553

Table 4. Concordance of Prediabetes Diagnoses Considering FG, PPG, and HbA1c

Test

Normal

Prediabetes

Total

Concordance (kappa)

Expected agreement

Agreement

FG: fasting glucose; Hb1Ac: glycosylated hemoglobin; PPG: postprandial glucose.

FG and PPG

419

455

0.6877

68.74%

90.24%

FG and HbA1c

427

455

0.6061

71.54%

88.79%

PPG and HbA1c

422

437

0.6812

69.37%

90.24%

Total

461

553

**Table 5.** Concordance of Diabetes Diagnoses Considering FG, PPG, and HbA1c
Test	Normal	Diabetes	Total	Concordance (kappa)	Expected agreement	Agreement
FG: fasting glucose; Hb1Ac: glycosylated hemoglobin; PPG: postprandial glucose.
FG and PPG	561	18	579	0.6616	85.79%	95.19%
FG and HbA1c	571	8	579	0.7503	87.17%	96.79%
PPG and HbA1c	565	8	573	0.6952	86.33%	95.83%
Total	583	41	624

Table 5. Concordance of Diabetes Diagnoses Considering FG, PPG, and HbA1c

Test

Normal

Diabetes

Total

Concordance (kappa)

Expected agreement

Agreement

FG: fasting glucose; Hb1Ac: glycosylated hemoglobin; PPG: postprandial glucose.

FG and PPG

561

579

0.6616

85.79%

95.19%

FG and HbA1c

571

579

0.7503

87.17%

96.79%

PPG and HbA1c

565

573

0.6952

86.33%

95.83%

Total

583

624