Abstract
BackgroundThe accuracy of different laboratory tests for diagnosis of diabetes mellitus (DM) and prediabetes (preDM) in populations exposed to tuberculosis (TB) remains poorly understood. Here, we examined the prevalence of DM and preDM in TB affected people in Lima, Peru.MethodsA prospective cohort study of patients affected TB and their household contacts (HHC), was conducted between February and November 2017 in Lima, Peru. Fasting plasma glucose (FPG), HbA1c and oral glucose tolerance test (OGTT) were used to detect DM and preDM in a prospective cohort of TB patients (n = 136) and household contacts (n = 138). Diagnostic performance of the laboratory tests was analyzed. Potential effects of sociodemographic and clinical factors on detection of dysglycemia were analyzed.ResultsIn TB patients, prevalence of DM and preDM was 13.97 and 30.88% respectively. Lower prevalence of both DM (6.52%) and preDM (28.99%) were observed in contacts. FPG, HbA1c and OGTT had poor agreement in detection of preDM in either TB cases or contacts. TB-DM patients had substantially lower hemoglobin levels, which resulted in low accuracy of HbA1c-based diagnosis. Classic sociodemographic and clinical characteristics were not different between TB patients with or without dysglycemia.ConclusionHigh prevalence of DM and preDM was found in both TB patients and contacts in Lima. Anemia was strongly associated with TB-DM, which directly affected the diagnostic performance of HbA1c in such population.
Highlights
The accuracy of different laboratory tests for diagnosis of diabetes mellitus (DM) and prediabetes in populations exposed to tuberculosis (TB) remains poorly understood
206 individuals were excluded for a number of reasons listed in Fig. 1a, and 143 patients with active TB were examined in the first study visit (Fig. 1a and Fig. 1b)
The DM prevalence was 13.97% (n = 19) among TB patients, while the prevalence of DM among Household contact (HHC) was 6.52% (n = 9)
Summary
The accuracy of different laboratory tests for diagnosis of diabetes mellitus (DM) and prediabetes (preDM) in populations exposed to tuberculosis (TB) remains poorly understood. World Health Organization (WHO) as the Peruvian National TB Program (NTP) recommend screening for DM in people with active TB and for TB between household contacts [5]. Despite those indications, most individuals are unaware of their DM or pre-DM status. In 2017, the Peruvian NTP communicated a DM incidence of 6.2% with a testing coverage of 77.9% of all TB patients whereas other instances of the national government reported in 2016 a DM incidence around 10.4% (government communication) Those differences may reflect several limitations in the DM screening such as the use of only fasting plasma glucose (FPG) as the screening approach [5]. It has been reported that HbA1c detects more people with DM [10] (or preDM) with higher sensitivity than other
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