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Título:
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Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa
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Autores:
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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.
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Tipo de documento:
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texto impreso
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Editorial:
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World Health Organization, 2018-11-08T19:39:21Z
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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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Objective 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. Methods 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. Findings 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. Conclusion 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.
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En línea:
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http://doi.org/10.2471/BLT.17.206227
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