A Largen1, A Ayala2, R Khurana2, D J Katz3, T K Venkatappa3, R Brostrom4. 1. Tuberculosis Control Program, Hawaii Department of Health, Honolulu, HI. 2. Maricopa County Department of Public Health, Phoenix, AZ. 3. Centers for Disease Control and Prevention, Atlanta, GA, USA. 4. Tuberculosis Control Program, Hawaii Department of Health, Honolulu, HI, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
BACKGROUND: Individuals with both diabetes mellitus (DM) and TB infection are at higher risk of progressing to TB disease. OBJECTIVE: To determine DM prevalence in populations at high risk for latent TB infection (LTBI) and to identify the most accurate point-of-care (POC) method for DM screening. METHODS: Adults aged ≥25 years were recruited at health department clinics in Hawaii and Arizona, USA, and screened for LTBI and DM. Screening methods for DM included self-report, random blood glucose (RBG), and POC hemoglobin A1c (HbA1c). Using HbA1c ≥6.5% or self-reported history as the gold standard for DM, we compared test strategies to determine the most accurate method while keeping test costs low. RESULTS: Of 472 participants, 13% had DM and half were unaware of their diagnosis. Limiting HbA1c testing to ages ≥30 years with a RBG level of 120-180 mg/dL helped identify most participants with DM (sensitivity 85%, specificity 99%) at an average test cost of US$2.56 per person compared to US$9.56 per person using HbA1c for all patients. CONCLUSION: Self-report was insufficient to determine DM status because many participants were previously undiagnosed. Using a combination of POC RBG and HbA1c provided an inexpensive option to assess DM status in persons at high risk for LTBI.
BACKGROUND: Individuals with both diabetes mellitus (DM) and TB infection are at higher risk of progressing to TB disease. OBJECTIVE: To determine DM prevalence in populations at high risk for latent TB infection (LTBI) and to identify the most accurate point-of-care (POC) method for DM screening. METHODS: Adults aged ≥25 years were recruited at health department clinics in Hawaii and Arizona, USA, and screened for LTBI and DM. Screening methods for DM included self-report, random blood glucose (RBG), and POC hemoglobin A1c (HbA1c). Using HbA1c ≥6.5% or self-reported history as the gold standard for DM, we compared test strategies to determine the most accurate method while keeping test costs low. RESULTS: Of 472 participants, 13% had DM and half were unaware of their diagnosis. Limiting HbA1c testing to ages ≥30 years with a RBG level of 120-180 mg/dL helped identify most participants with DM (sensitivity 85%, specificity 99%) at an average test cost of US$2.56 per person compared to US$9.56 per person using HbA1c for all patients. CONCLUSION: Self-report was insufficient to determine DM status because many participants were previously undiagnosed. Using a combination of POC RBG and HbA1c provided an inexpensive option to assess DM status in persons at high risk for LTBI.
Authors: Marissa M Barron; Kate M Shaw; Kai McKeever Bullard; Mohammed K Ali; Matthew J Magee Journal: Diabetes Res Clin Pract Date: 2018-03-21 Impact factor: 5.602
Authors: Charlotte Jackson; Jo Southern; Ajit Lalvani; Francis Drobniewski; Chris J Griffiths; Marc Lipman; Graham H Bothamley; Jonathan J Deeks; Ambreen Imran; Onn Min Kon; Sithembinkosi Mpofu; Vladyslav Nikolayevskyy; Melanie Rees-Roberts; Alice Sitch; Saranya Sridhar; Chuen-Yan Tsou; Hilary Whitworth; Ibrahim Abubakar Journal: Thorax Date: 2018-05-15 Impact factor: 9.139