Comparison of three methods for diabetes screening in a rural clinic in Honduras Comparación de tres métodos para el tamizaje de la diabetes en un consultorio rural en Honduras

• Main Authors: John D Piette, Evan C Milton, Allison E Aiello, Milton O Mendoza-Avelares, William H Herman
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2010
• Subjects: Diabetes mellitus tipo 2; población rural; diagnóstico; técnicas y procedimientos diagnósticos; Honduras; Diabetes mellitus; type 2; rural population; diagnosis; diagnostic techniques and procedures; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/bd77fa7850cd460bbd385bc46f080669

OBJECTIVE: To evaluate two alternatives to the fasting plasma glucose (FPG) test for diabetes screening in Latin America. METHODS: Eight hundred adults without diabetes were recruited in a primary care clinic in Honduras. An equation-based screening formula, incorporating a random capillary glucose test and other risk factors, was used for initial screening. All patients with a screening-based probability of diabetes > 20%, plus one-fifth of those with a probability < 20%, were asked to return for FPG and point-of-care hemoglobin A1c (POC-A1c) tests. An FPG > 126 milligrams per deciliter and a POC-A1c > 6.5% were used as gold standards to assess the performance of the screening equation. The association between the POC-A1c and the FPG tests was examined as were patient factors associated with failure to return for follow-up and variation in diabetes risk across subgroups. RESULTS: The screening equation had excellent test characteristics compared with FPG and POC-A1c. Using the FPG gold standard, the POC-A1c had a sensitivity of 77.8% and a specificity of 84.9%. With an A1c cutoff of 7%, POC-A1c specificity increased to 96.2%. Thirty-four percent of patients asked to return for follow-up testing failed to do so. Those who failed to return were more likely to be men and to have hypertension. CONCLUSIONS: Both the screening equation and POC-A1c are reasonable alternatives to an FPG test for identifying patients with diabetes. Given the barriers to currently recommended screening procedures, these options could have important public health benefits in Latin America. OBJETIVO: Evaluar dos alternativas a la prueba de glucemia en ayunas para el tamizaje de la diabetes en América Latina. MÉTODOS: Se seleccionaron 800 adultos sin diabetes que acudían a un dispensario de atención primaria en Honduras. Para el tamizaje inicial se utilizó una fórmula de tamizaje mediante la aplicación de ecuaciones, que incluía una prueba aleatoria de la concentración de glucosa capilar y otros factores de riesgo. A todos los ...