P Huangfu1, Y V Laurence2, B Alisjahbana3, C Ugarte-Gil4, A-L Riza5, G Walzl6, R Ruslami3, D A J Moore7, M Ioana8, S McAllister9, K Ronacher10, R C Koesoemadinata3, D Grint1, S Kerry1, J Coronel11, S T Malherbe6, U Griffiths12, H M Dockrell13, P C Hill9, R van Crevel14, F Pearson1, J A Critchley1. 1. Population Health Research Institute, St George's University of London, London. 2. Department of Global Health and Development, Faculty of Public Health and Policy, TB Centre, London School of Hygiene & Tropical Medicine, London, UK. 3. Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 4. Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. 5. Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. 6. Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. 7. Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, TB Centre, London School of Hygiene & Tropical Medicine, London, UK. 8. Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Dolj Regional Centre of Medical Genetics, Emergency County Clinical Hospital Craiova, Romania. 9. Centre for International Health, University of Otago, Dunedin, New Zealand. 10. Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Mater Medical Research, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia. 11. Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia Lima, Peru. 12. Department of Global Health and Development, Faculty of Public Health and Policy. 13. Department of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK. 14. Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
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.
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 TBpatients 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 TBpatients 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 TBpatients.
Authors: O W Akkerman; R Duarte; S Tiberi; H S Schaaf; C Lange; J W C Alffenaar; J Denholm; A C C Carvalho; M S Bolhuis; S Borisov; J Bruchfeld; A M Cabibbe; J A Caminero; I Carvalho; J Chakaya; R Centis; M P Dalcomo; L D Ambrosio; M Dedicoat; K Dheda; K E Dooley; J Furin; J-M García-García; N A H van Hest; B C de Jong; X Kurhasani; A G Märtson; S Mpagama; M Munoz Torrico; E Nunes; C W M Ong; D J Palmero; R Ruslami; A M I Saktiawati; C Semuto; D R Silva; R Singla; I Solovic; S Srivastava; J E M de Steenwinkel; A Story; M G G Sturkenboom; M Tadolini; Z F Udwadia; A R Verhage; J P Zellweger; G B Migliori Journal: Int J Tuberc Lung Dis Date: 2022-07-01 Impact factor: 3.427
Authors: Laura V White; Tansy Edwards; Nathaniel Lee; Mary C Castro; Naomi R Saludar; Rugaiya W Calapis; Benjamin N Faguer; Nelson Dela Fuente; Ferdinand Mayoga; Nobuo Saito; Koya Ariyoshi; Anna Marie Celina G Garfin; Juan A Solon; Sharon E Cox Journal: Sci Rep Date: 2020-03-05 Impact factor: 4.379
Authors: Kattya Lopez; María B Arriaga; Juan G Aliaga; Nadia N Barreda; Oswaldo M Sanabria; Chuan-Chin Huang; Zibiao Zhang; Ruth García-de-la-Guarda; Leonid Lecca; Anna Cristina Calçada Carvalho; Afrânio L Kritski; Roger I Calderon Journal: PLoS One Date: 2021-01-28 Impact factor: 3.240