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Comparative study of HbA 1c and fasting plasma glucose vs the oral glucose tolerance test for diagnosis of diabetes in people with tuberculosis
Author(s) -
Aftab H.,
Ambreen A.,
Jamil M.,
Garred P.,
Petersen J. H.,
Nielsen S. D.,
Bygbjerg I. C.,
Christensen D. L.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13354
Subject(s) - medicine , diabetes mellitus , plasma glucose , glucose tolerance test , tuberculosis , receiver operating characteristic , endocrinology , impaired glucose tolerance , area under the curve , gastroenterology , impaired fasting glucose , type 2 diabetes , insulin resistance , pathology
Aim To compare HbA 1c and fasting plasma glucose assessment, with the 2‐h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis. Methods Individuals ( N =268) with newly diagnosed smear‐positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA 1c and ≥7.0mmol/l for fasting plasma glucose. Results The proportion of participants diagnosed with diabetes was 4.9% ( n = 13) by oral glucose tolerance test, while 11.9% ( n = 32) and 14.6% ( n = 39) were diagnosed with diabetes using HbA 1c and fasting plasma glucose criteria, respectively. The area under the receiver‐operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA 1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests ( P =0.07). Conclusions HbA 1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA 1c may be a more reliable test in individuals with transient hyperglycaemia.