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Point of care HbA1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries

Huangfu, P; Laurence, YV; Alisjahbana, B; Ugarte-Gil, C; Riza, A-L; Walzl, G; Ruslami, R; Moore, DAJ; Ioana, M; McAllister, S; et al. Huangfu, P; Laurence, YV; Alisjahbana, B; Ugarte-Gil, C; Riza, A-L; Walzl, G; Ruslami, R; Moore, DAJ; Ioana, M; McAllister, S; Ronacher, K; Koesoemadinata, RC; Grint, D; Kerry, S; Coronel, J; Malherbe, ST; Griffiths, U; Dockrell, HM; Hill, PC; Van Crevel, R; Pearson, F; Critchley, J; TANDEM Consortium (2019) Point of care HbA1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 23 (3). pp. 283-292. ISSN 1027-3719 https://doi.org/10.5588/ijtld.18.0359
SGUL Authors: Critchley, Julia Pearson, Fiona Huangfu, Peijue

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Abstract

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 (HbA1c) 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 HbA1c (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 ± 2 standard deviations) stratified by country, age, sex, body mass index (BMI), HbA1c level and comorbidities (anaemia, human immunodeficiency virus [HIV]). We used an error grid approach to identify disagreement that could raise significant concerns. RESULTS: Overall mean POC HbA1c values were modestly higher than laboratory HbA1c levels by 0.1% units (95%CI 0.1–0.2); however, there was a substantial discrepancy for those with severe anaemia (1.1% HbA1c, 95%CI 0.7–1.5). For 89.6% of 1942 patients, both values indicated the same DM status (no DM, HbA1c <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 HbA1c 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 HbA1c is pragmatic and sufficiently accurate to screen for hyperglycaemia and DM risk among TB patients.

Item Type: Article
Additional Information: © 2019 The Union
Keywords: 1102 Cardiovascular Medicine And Haematology, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
ISSN: 1027-3719
Dates:
DateEvent
1 March 2019Published
3 August 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
305279Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
1U01AI115619-01National Institutes of Healthhttp://dx.doi.org/10.13039/100000002
7-627-3-167Qatar Foundationhttp://dx.doi.org/10.13039/100007458
URI: https://openaccess.sgul.ac.uk/id/eprint/110548
Publisher's version: https://doi.org/10.5588/ijtld.18.0359

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