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Comparison of fasting plasma glucose and haemoglobin A1c point-of-care tests in screening for diabetes and abnormal glucose regulation in a rural low income setting
Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Department of Internal Medicine, Mulago National Referral and Hospital, Kampala, Uganda.
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2014 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 104, no 1, 112-120 p.Article in journal (Refereed) Published
Abstract [en]

Aims

Glycated haemoglobin (HbA1C) has been suggested to replace glucose tests in identifying diabetes and pre-diabetes. We assessed agreement between fasting plasma glucose (FPG) and HbA1C rapid tests in classifying abnormal glucose regulation (AGR), and their utility for preventive screening in rural Africa.

Methods

A population-based survey of 795 people aged 35–60 years was conducted in a mainly rural district in Uganda. FPG was measured using On-Call® Plus glucometers, and classified using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. HbA1C was measured using A1cNow® kits and classified using ADA criteria. Body mass index and blood pressure were measured. Percentage agreement between the two tests was computed.

Results

Using HbA1C, 11.3% of participants had diabetes compared with 4.8% for FPG. Prevalence of HbA1C-defined pre-diabetes (26.4%) was 1.2 times and 2.5 times higher than FPG-defined pre-diabetes using ADA (21.8%) and WHO (10.1%) criteria, respectively. With FPG as the reference, agreement between FPG and HbA1C in classifying diabetes status was moderate (Kappa = 22.9; Area Under the Curve (AUC) = 75%), while that for AGR was low (Kappa = 11.0; AUC = 59%). However, agreement was high (over 90%) among negative tests and among participants with risk factors for type 2 diabetes (obesity, overweight or hypertension). HbA1C had more procedural challenges than FPG.

Conclusions

Although low in the general sample, agreement between HbA1C and FPG is excellent among persons who test negative with either test. A single test can therefore identify the majority at lower risk for type 2 diabetes. Nurses if trained can conduct these tests.

Place, publisher, year, edition, pages
2014. Vol. 104, no 1, 112-120 p.
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-217113DOI: 10.1016/j.diabres.2013.12.030ISI: 000334583200019PubMedID: 24456993OAI: oai:DiVA.org:uu-217113DiVA: diva2:691982
Available from: 2014-01-29 Created: 2014-01-29 Last updated: 2017-12-06Bibliographically approved

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