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Glycated haemoglobin A1c (HbA1c) for detection of diabetes mellitus and impaired fasting glucose in Malawi: a diagnostic accuracy study

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Rathod, Sujit D, Crampin, Amelia C, Musicha, Crispin, Kayuni, Ndoliwe, Banda, Louis, Saul, Jacqueline, McLean, Estelle, Branson, Keith, Jaffar, Shabbar ORCID: https://orcid.org/0000-0002-9615-1588 and Nyirenda, Moffat J (2018) 'Glycated haemoglobin A1c (HbA1c) for detection of diabetes mellitus and impaired fasting glucose in Malawi: a diagnostic accuracy study'. BMJ Open, Vol 8, Issue 5, e020972.

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Abstract

Objectives
To examine the accuracy of glycated haemoglobin A1c (HbA1c) in detecting type 2 diabetes and impaired fasting glucose among adults living in Malawi.
Design
A diagnostic validation study of HbA1c. Fasting plasma glucose (FPG) ≥7.0 mmol/L was the reference standard for type 2 diabetes, and FPG between 6.1 and 6.9 mmol/L as impaired fasting glucose.
Participants
3645 adults (of whom 63% were women) recruited from two demographic surveillance study sites in urban and rural Malawi. This analysis excluded those who had a previous diagnosis of diabetes or had history of taking diabetes medication.
Results
HbA1c demonstrated excellent validity to detect FPG-defined diabetes, with an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 to 0.94). At HbA1c ≥6.5% (140 mg/dL), sensitivity was 78.7% and specificity was 94.0%. Subgroup AUROCs ranged from 0.86 for participants with anaemia to 0.94 for participants in urban Malawi. There were clinical and metabolic differences between participants with true diabetes versus false positives when HbA1c was ≥6.5% (140 mg/dL).
Conclusions
The findings from this study provide justification to use HbA1c to detect type 2 diabetes. As HbA1c testing is substantially less burdensome to patients than either FPG testing or oral glucose tolerance testing, it represents a useful option for expanding access to diabetes care in sub-Saharan Africa.

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WK Endocrine System > WK 20 Research (General)
WK Endocrine System > WK 810 Diabetes mellitus
WK Endocrine System > WK 818 Diet
WK Endocrine System > WK 820 Insulin and its modifications
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjopen-2017-020972
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 10 May 2018 14:16
Last Modified: 24 Oct 2019 08:20
URI: https://archive.lstmed.ac.uk/id/eprint/8584

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