Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

OBJECTIVE: To assess the diagnostic accuracy of HbA1c , compared to fasting plasma glucose (FPG) and the oral glucose tolerance test (OGTT), in screening for type 2 diabetes (T2D) in Africa. METHODS: We systematically searched databases for studies that compared the HbA1C to either the OGTT, or the FPG for T2D diagnosis were included. The QUADAS 2 tool was used for assessing the quality of included studies. We used the split component synthesis (SCS) method for the meta-analysis of diagnostic accuracy studies to pool the studies for meta-analysis of sensitivity and specificity, primarily at the HbA1C ≥48mmol/mol (6.5%) cut-off and at other cut-offs. We assessed heterogeneity using the I2 statistic and publication bias using Doi plots. RESULTS: Eleven studies, from seven African countries, with 12925 participants, were included. Against the OGTT, HbA1C ≥48mmol/mol (6.5%) had a pooled sensitivity of 57.7% (95%CI 43.4-70.9) and specificity of 92.3% (95%CI 83.9 - 96.5). Against the FPG, HbA1C ≥48mmol/mol (6.5%) had a pooled sensitivity of 64.5% (95%CI 50.5 - 76.4) and specificity of 94.3% (95%CI 87.9 - 97.5). The highest sensitivity for HbA1C , against the OGTT, was at the 42mmol/mol (6.0%) cut off. CONCLUSION: In Africa, the HbA1C ≥48mmol/mol (6.5%) cut-off may miss almost half of the individuals with T2D based on blood glucose measures.

Original publication

DOI

10.1111/dme.14754

Type

Journal article

Journal

Diabet Med

Publication Date

01/12/2021

Keywords

Africa, Type 2 diabetes mellitus, diagnostic accuracy, glycated haemoglobin A1C, sensitivity, specificity