Advertisement

Evaluation of performance of A1c and FPG tests for screening newly diagnosed diabetes defined by an OGTT among tuberculosis patients—A study from India

  • Satyavani Kumpatla
    Affiliations
    M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu, India
    Search for articles by this author
  • Vigneswari Aravindalochanan
    Affiliations
    M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu, India
    Search for articles by this author
  • Rajeswari Rajan
    Affiliations
    M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu, India
    Search for articles by this author
  • Vijay Viswanathan
    Correspondence
    Corresponding author at: M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600013, Tamil Nadu, India. Tel.: +91 44 2595 49 13–15; fax: +91 44 2595 49 19.
    Affiliations
    M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu, India
    Search for articles by this author
  • Anil Kapur
    Affiliations
    World Diabetes Foundation, Gentofte, Denmark
    Search for articles by this author
Published:September 16, 2013DOI:https://doi.org/10.1016/j.diabres.2013.08.007

      Abstract

      Aim

      The methods used for diagnosis of diabetes have limitations particularly in situations associated with stress hyperglycemia. Aim of this study was to evaluate the performance of A1c and fasting plasma glucose (FPG) tests for screening newly diagnosed diabetes (NDD) defined by OGTT among tuberculosis (TB) cases in India.

      Methods

      A total of 983 subjects aged ≥18 years with TB were selected from 7 TB units – 4 urban, 2 rural and 1 semi-urban areas of Tamil Nadu, India, during August 2010–March 2011. Screening for diabetes was carried out by 2-h 75 g OGTT. Classification of glucose intolerance status was based on WHO criteria. HbA1c was measured by high performance liquid chromatography using Bio-Rad turbo machine. HbA1c ≥ 47.5 mmol/mol was used for diagnosis of diabetes. FPG was estimated by glucose-oxidase method. Known cases of subjects with diabetes were excluded and final analysis was done using data of 779 individuals. The performance of A1c and FPG tests was evaluated against the results of OGTT using receiver operating characteristic curve analysis.

      Results

      Prevalence of NDD was 10.8%. The areas under the curve (AUC) were 0.754 [95% confidence interval (CI) 0.68–0.83] (p < 0.001) for A1c and 0.662 (95% CI 0.58–0.74) for FPG (p < 0.001) in NDD subjects. The HbA1c cut-off point of ≥47.5 mmol/mol gave a sensitivity of 59.1% and specificity of 91.7%, and the respective values were 34.8% and 97.5% for FPG in subjects with NDD.

      Conclusion

      HbA1c performed better than FPG as a screening tool for newly diagnosed diabetes among subjects with TB.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. International Diabetes Federation International Diabetes Federation Atlas.
        5th ed. International Diabetes Federation, Brussels, Belgium2011
        • World Health Organization
        Global Tuberculosis Control 2009: Epidemiology, Strategy, Financing.
        World Health Organization, Geneva, Switzerland2010 (Available at: www.whoint/tb/publications/global_report/2009 [accessed 10.11.12])
        • Jeon C.Y.
        • Murray M.B.
        Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies.
        PLoS Med. 2008; 5: e152
        • Vijay V.
        • Satyavani K.
        • Vigneswari A.
        • Rajeswari R.
        • Chinnasamy C.
        • Srinivasan R.
        • et al.
        Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India.
        PLoS ONE. 2012; 7: e41367
        • Balakrishnan S.
        • Vijayan S.
        • Nair S.
        • Subramoniapillai J.
        • Mrithyunjayan S.
        • Wilson N.
        • et al.
        High diabetes prevalence among tuberculosis cases in Kerala, India.
        PLoS ONE. 2012; 7: e46502
        • World Health Organization
        Definition, diagnosis and classification of diabetes mellitus and its complications.
        Report of WHO consultation. Part 1: Diagnosis and classification of diabetes mellitus. World Health Organization, Geneva1999
        • Lipska K.J.
        • De Rekeneire N.
        • Van Ness P.H.
        • Johnson K.C.
        • Kanaya A.
        • Koster A.
        • et al.
        Identifying dysglycemic states in older adults: implications of the emerging use of hemoglobin A1c.
        J Clin Endocrinol Metab. 2010; 95: 5289-5295
        • Bonora E.
        • Tuomilehto J.
        Pros and cons of diagnosing diabetes with A1c.
        Diabetes Care. 2011; 34: 184-190
        • The International Expert Committee
        International Expert committee report on the role of the A1c assay in the diagnosis of diabetes.
        Diabetes Care. 2009; 32: 1327-1334
        • Gomez-Perez F.J.
        • Aguitar-Salinas C.A.
        • Almeda-Valdes P.
        • Cuevas-Ramos D.
        • Garber I.L.
        • Rull J.A.
        HbA1c for the diagnosis of diabetes mellitus in a developing country. A position article.
        Arch Med Res. 2010; 41: 302-308
        • Kilpatrick E.S.
        • Rigby A.S.
        • Atkin S.L.
        Variability in the relationship between mean plasma glucose and HbA1c: implications for the assessment of glycemic control.
        Clin Chem. 2007; 53: 897-901
        • Zhou X.
        • Pang Z.
        • Gao W.
        • Wang S.
        • Zhang L.
        • Ning F.
        • et al.
        Performance of an A1c and fasting capillary blood glucose test for screening newly diagnosed diabetes and pre-diabetes defined by an oral glucose tolerance test in Qingdao, China.
        Diabetes Care. 2010; 33: 545-550
        • Mohan V.
        • Vijayachandrika V.
        • Gokulakrishnan K.
        • Anjana R.M.
        • Ganesan A.
        • Weber M.B.
        • Venkat Narayan K.M.
        A1c cut points to define various glucose intolerance groups in Asian Indians.
        Diabetes Care. 2010; 33: 515-519
        • Maria Rosario G.A.
        • Grandinetti A.
        • Chang H.K.
        A1c and diabetes diagnosis among Filipino Americans, Japanese Americans, and Native Hawaiians.
        Diabetes Care. 2010; 33: 2626-2628
        • Ghazanfari Z.
        • Haghdoost A.A.
        • Alizadeh S.M.
        • Atapour J.
        • Zolala F.
        A comparison of HbA1c and fasting blood sugar tests in general population.
        Int J Prev Med. 2010; 1: 187-194
      2. RNTCP at a glance. Available at: http://uttarkashi.nic.in/Dept/Health/RNTCP/RNTCP.pdf [accessed 25.02.12].

        • American Diabetes Association Standards of Medical Care in Diabetes-2010
        Diabetes Care. 2010; 33: S11-S61
        • Akobeng A.K.
        Understanding diagnostic tests 3: receiver operating characteristic curves.
        Acta Paediatr. 2007; 96: 644-647
        • Bao Y.
        • Ma X.
        • Li H.
        • Zhou M.
        • Hu C.
        • Wu H.
        • et al.
        Glycated heamoglobin A1c for diagnosing diabetes in Chinese population. Cross sectional epidemiological survey.
        BMJ. 2010; 340: 2249-2257
        • Ibrahim H.
        • Bt Ismail A.H.
        • Ismail S.B.
        • Bebakar W.M.W.
        The use of HbA1C in the diagnosis of diabetes mellitus type 2 in high risk subjects.
        Int J Diabetes Metab. 2010; 18: 25-28
        • Peterson P.H.
        • Jørgensen L.G.
        • Brandslund I.
        • De Fine Olivarius N.
        • Stahl M.
        Consequences of bias and inprecision in measurements of glucose and HbA1c for the diagnosis and prognosis of diabetes mellitus.
        Scand J Clin Lab Invest Suppl. 2005; 240: 51-60