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- Title
Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa.
- Authors
Grint, Daniel; Alisjhabana, Bachti; Ugarte-Gil, Cesar; Riza, Anca-Leila; Walzl, Gerhard; Pearson, Fiona; Ruslami, Rovina; Moore, David A. J.; Ioana, Mihai; McAllister, Susan; Ronacher, Katharina; Koeseomadinata, Raspati C.; Kerry-Barnard, Sarah R.; Coronel, Jorge; Malherbe, Stephanus T.; Dockrell, Hazel M.; Hill, Philip C.; Van Crevel, Reinout; Critchley, Julia A.
- Abstract
Objective To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries. Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L. Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6-14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75-0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81-0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru. Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation.
- Subjects
INDONESIA; PERU; ROMANIA; SOUTH Africa; DIAGNOSIS of diabetes; DIABETES risk factors; TUBERCULOSIS complications; TUBERCULOSIS diagnosis; ANTHROPOMETRY; BIOMARKERS; BLOOD sugar; CONFIDENCE intervals; DIABETES; FASTING; GLYCOSYLATED hemoglobin; HYPERGLYCEMIA; HOSPITAL information systems; LONGITUDINAL method; MEDICAL cooperation; MEDICAL screening; RESEARCH; RESEARCH evaluation; RISK assessment; URINALYSIS; DISEASE prevalence; MIDDLE-income countries; LOW-income countries
- Publication
Bulletin of the World Health Organization, 2018, Vol 96, Issue 11, p738
- ISSN
0042-9686
- Publication type
Article
- DOI
10.2471/BLT.17.206227