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
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Diabetes Research and Clinical Practice
Abstract
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-Call1 Plus glucometers, and
classified using World Health Organization (WHO) and American Diabetes Association
(ADA) criteria. HbA1C was measured using A1cNow1 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.
Description
Keywords
Diabetes, Abnormal glucose regulation, Early detection, Fasting plasma glucose, Haemoglobin A1C, Percentage agreement
Citation
Mayega, R. W., Guwatudde, D., Makumbi, F. E., Nakwagala, F. N., Peterson, S., Tomson, G., & Östenson, C. G. (2014). 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. Diabetes Research and Clinical Practice, 104(1), 112-120. http://dx.doi.org/10.1016/j.diabres.2013.12.030