Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa

• Published in: Bulletin of the World Health Organization Vol. 96; no. 11; pp. 738 - 749
• Main 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
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.11.2018
• Subjects: Accuracy; Adult; Age Factors; Anthropometry; Blood; Blood Glucose; Body mass index; Body Weights and Measures; Confidence intervals; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diagnostic software; Diagnostic systems; Disease; Exercise; Family medical history; Fasting; Female; Fruits; Gestational diabetes; Glucose; Glycated Hemoglobin A; Health risk assessment; Health risks; Hemoglobin; Heterogeneity; Humans; Hyperglycemia; Indonesia; Intervention; Laboratories; Laboratory methods; Male; Mass Screening - methods; Medical screening; Middle Aged; Newly diagnosed; Patients; Performance evaluation; Peru; Plasma; Point-of-Care Testing; Prospective Studies; Risk; Risk Factors; ROC Curve; Romania; Sex Factors; South Africa; Trust; Tuberculosis; Tuberculosis - epidemiology; Urine; Validity; South Africa; Romania; Peru; Indonesia; United Kingdom > UK; India
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.17.206227

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. 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. 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. 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.