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Título:
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Point of care HbA1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries
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Autores:
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Huangfu, P. ;
Laurence, Y.V. ;
Alisjahbana, B. ;
Ugarte-Gil, C. ;
Riza, A.-L. ;
Walzl, G. ;
Ruslami, R. ;
Moore, D.A.J. ;
Ioana, M. ;
McAllister, S. ;
Ronacher, K. ;
Koesoemadinata, R.C. ;
Grint, D. ;
Kerry, S. ;
Coronel, J. ;
Malherbe, S.T. ;
Griffiths, U. ;
Dockrell, H.M. ;
Hill, P.C. ;
van Crevel, R. ;
Pearson, F. ;
Critchley, J.A.
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Tipo de documento:
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texto impreso
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Editorial:
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International Union Against Tuberculosis and Lung Disease, 2019-07-04T17:00:21Z
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Nota general:
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info:eu-repo/semantics/restrictedAccess
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
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Idiomas:
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Inglés
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Palabras clave:
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Editados por otras instituciones
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Artículos
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Artículos en revistas indizadas
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Resumen:
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BACKGROUND: Diabetes mellitus (DM) is common among tuberculosis (TB) patients and often undiagnosed or poorly controlled. We compared point of care (POC) with laboratory glycated haemoglobin (HbA 1c ) testing among newly diagnosed TB patients to assess POC test accuracy, safety and acceptability in settings in which immediate access to DM services may be difficult. METHODS : We measured POC and accredited laboratory HbA 1c (using high-performance liquid chromatography) in 1942 TB patients aged ?18 years recruited from Peru, Romania, Indonesia and South Africa. We calculated overall agreement and individual variation (mean 6 2 standard deviations) stratified by country, age, sex, body mass index (BMI), HbA 1c level and comorbidities (anaemia, human immunodeficiency virus [HIV]). We used an error grid approach to identify disagreement that could raise significant concerns. R E SULT S : Overall mean POC HbA 1c values were modestly higher than laboratory HbA 1c levels by 0.1% units (95%CI 0.1-0.2); however, there was a substantial discrepancy for those with severe anaemia (1.1% HbA 1c , 95%CI 0.7-1.5). For 89.6% of 1942 patients, both values indicated the same DM status (no DM, HbA 1c ,6.5%) or had acceptable deviation (relative difference ,6%). Individual agreement was variable, with POC values up to 1.8% units higher or 1.6% lower. For a minority, use of POC HbA 1c alone could result in error leading to potential overtreatment (n = 40, 2.1%)or undertreatment (n = 1, 0.1%). The remainder had moderate disagreement, which was less likely to influence clinical decisions. CONCLUSION: POC HbA 1c is pragmatic and sufficiently accurate to screen for hyperglycaemia and DM risk among TB patients. © 2019 The Union.
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En línea:
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http://doi.org/10.5588/ijtld.18.0359
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