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Glycated haemoglobin A 1 c ( HbA 1 c ) for detection of diabetes mellitus and impaired fasting glucose in Malawi : a diagnostic accuracy study
| Content Provider | Semantic Scholar |
|---|---|
| Author | Rathod, Sujit D. Crampin, Amelia Musicha, Crispin Kayuni, Ndoliwe Banda, Louis Saul, Jacqueline Mclean, Estelle M. Branson, Keith Jaffar, Shabbar Nyirenda, Moffat J. |
| Copyright Year | 2018 |
| Abstract | Objectives To examine the accuracy of glycated haemoglobin A1c (HbA1c) in detecting type 2 diabetes and impaired fasting glucose among adults living in Malawi. Design A diagnostic validation study of HbA1c. Fasting plasma glucose (FPG) ≥7.0 mmol/L was the reference standard for type 2 diabetes, and FPG between 6.1 and 6.9 mmol/L as impaired fasting glucose. Participants 3645 adults (of whom 63% were women) recruited from two demographic surveillance study sites in urban and rural Malawi. This analysis excluded those who had a previous diagnosis of diabetes or had history of taking diabetes medication. results HbA 1c demonstrated excellent validity to detect FPG-defined diabetes, with an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 to 0.94). At HbA 1c ≥6.5% (140 mg/dL), sensitivity was 78.7% and specificity was 94.0%. Subgroup AUROCs ranged from 0.86 for participants with anaemia to 0.94 for participants in urban Malawi. There were clinical and metabolic differences between participants with true diabetes versus false positives when HbA 1c was ≥6.5% (140 mg/dL). Conclusions The findings from this study provide justification to use HbA 1c to detect type 2 diabetes. As HbA1c testing is substantially less burdensome to patients than either FPG testing or oral glucose tolerance testing, it represents a useful option for expanding access to diabetes care in sub-Saharan Africa. IntrODuCtIOn Over 400 million people live with type 2 diabetes worldwide, with more than 75% of these in low/middle-income countries. While the prevalence of diabetes in sub-Saharan African is lower than in other global regions, around 6%–9%, 3 demographic models project that this region will experience the fastest growth rate in cases over the next 20 years. Approximately 50%–66% of people with diabetes are undiagnosed, 4 and complications are common even after diagnosis. As barriers to diabetes care become surmounted in this region, focus must turn to improving the accessibility of diagnostics. The diagnosis of diabetes has traditionally been based on the detection of elevated plasma glucose levels, either after fasting or 2 hours after an oral glucose tolerance test, or, in symptomatic individuals, after a random blood glucose check. While these tests are available in sub-Saharan Africa, access to services is limited, travel times and clinic waiting times are high and integrity of the samples and quality of the measuring tools are in most cases uncertain. More reliable approaches to circumvent some of these challenges are required. Recently, the American Diabetes Association and the WHO have recommended using glycated haemoglobin A1c (HbA1c) in blood to diagnose diabetes mellitus. 8 HbA1c testing provides significant practical advantages over glucose testing as it does not fluctuate appreciably and thus can be performed at any time of the day. Further, HbA1c testing does not require any special pretest preparations, such as overnight fasting or glucose loading. There are acknowledged limitations when attempting to measure HbA1c levels which may be relevant for diagnostics in strengths and limitations of this study ► Only two studies have assessed the validity of glycated haemoglobin A1c to detect type 2 diabetes in African-origin populations; this is the first such |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://archive.lstmed.ac.uk/8584/1/BMJ_OPEN_Glycated%20haemoglobin%20A1c%20(HbA1c)%20for%20detection%20of%20diabetes%20mellitus.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
