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Background In subjects who present a first fasting plasma glucose (FPG 1 ) ≥ 7.0 mmol/l without classic symptoms of diabetes, diagnosis of diabetes will likely be missed without an additional oral glucose tolerance test (OGTT) in the Chinese population. Recent studies have shown that glycated albumin (GA) has advantages in reflecting postprandial hyperglycemia. Therefore, the present study evaluated whether additional measurement of GA could reduce the rate of missed diagnosis of diabetes. Methods A total of 1287 participants (711 men, 576 women) with a FPG 1 ≥ 7.0 mmol/l without classic symptoms of diabetes were enrolled and underwent a 75-g OGTT. Serum GA was measured by a liquid enzyme method. Diabetes was diagnosed based on the 2010 American Diabetes Association (ADA) criteria. Results A total of 992 (77.08%) participants were diagnosed diabetes by OGTT and glycated hemoglobin A 1c (HbA 1c ). The diagnostic validity of 2-h postload plasma glucose (2hPG) was superior to other glycemic index (the diagnostic sensitivity of 2hPG, HbA 1c , the second FPG (FPG 2 ) was 87.50%, 73.99%, 63.21%, respectively). Without 2hPG after OGTT, repeat testing of FPG 2 alone would result in missed diagnosis of 36.79% of diabetic participants, whereas testing FPG 2 with HbA 1c was associated with a missed diagnosis rate of 14.31%. While using the combined criteria of FPG 2 ≥ 7.0 mmol/l and/or HbA 1c ≥ 6.5% and/or GA ≥ 17.1%, the rate of missed diagnosis was merely 9.48%. That is, the rate of missed diagnosis was reduced by 33.75% with the addition of GA measurement. The k value reflecting the consistency of diagnosis between the FPG 2 and/or HbA 1c and/or GA criteria and the 2010 ADA criteria was 0.788. Conclusions For subjects with FPG 1 ≥ 7.0 mmol/l without classic symptoms of diabetes, additional measurement of GA can help prevent missed diagnosis of diabetes in Chinese population. [ABSTRACT FROM AUTHOR]