Abstract
BackgroundFasting plasma glucose (FPG) is the most commonly used screening tool for diabetes in Sri Lanka. Cut-off values from American Diabetes Association recommendations are adopted in the absence of local data. We aimed to establish FPG cut offs for Sri Lankans to screen for diabetes and pre-diabetes.MethodsData on FPG and diabetes/pre-diabetes status were obtained from Sri Lanka Diabetes and Cardiovascular Study (SLDCS), a community based island wide observational study conducted in 2005–6. Sensitivity specificity and area under the ROC curve were calculated for different FPG values.ResultsStudy included 4014 community dwelling people after excluding people already on treatment for diabetes or pre-diabetes. Mean age was 45.3 (± 15) years and 60.4% were females. FPG cut off of 5.3 mmol/L showed better sensitivity and specificity than 5.6 mmol/L in detecting diabetes (87.8% and 84.4% Vs 80.8% and 92.1%) and pre-diabetes (54.7% and 87.0% Vs 43.8% and 94.2%).ConclusionsA lower FPG cut off of 5.3 mmol/L has a better sensitivity and acceptable specificity in screening for diabetes and pre-diabetes in Sri Lankan adults.
Highlights
Fasting plasma glucose (FPG) is the most commonly used screening tool for diabetes in Sri Lanka
Fasting Plasma Glucose (FPG) of ≥ 7.0 mmol/l, 2-h plasma glucose of ≥ 11.1 mmol/L after a standard 75 g Oral Glucose Tolerance Test (OGTT), Glycated haemoglobin A1 (HbA1c) value of ≥ 6.5% and a casual blood glucose value of ≥ 11.1 mmol/ L in a patient with classic symptoms of hyperglycemia are the criteria recommended by the American Diabetes Association (ADA) for diagnosis of diabetes mellitus [4]
Sri Lanka Diabetes and Cardiovascular Study (SLDCS) was a cross sectional study conducted by the Diabetes Research Unit of the Faculty of Medicine, University of Colombo and the Oxford Centre for Diabetes Endocrinology and Metabolism of the University of Oxford UK
Summary
Fasting plasma glucose (FPG) is the most commonly used screening tool for diabetes in Sri Lanka. Fasting Plasma Glucose (FPG) of ≥ 7.0 mmol/l, 2-h plasma glucose of ≥ 11.1 mmol/L after a standard 75 g Oral Glucose Tolerance Test (OGTT), HbA1c value of ≥ 6.5% and a casual blood glucose value of ≥ 11.1 mmol/ L in a patient with classic symptoms of hyperglycemia are the criteria recommended by the ADA for diagnosis of diabetes mellitus [4]. Many tend to use HbA1c as a screening test for diagnosis as it does not require patients to fast and reflects longer-term glycaemia than plasma glucose [5,6,7]. In resource limited settings the lack of standardization, relative unavailability and high cost of the HbA1c assay promote FPG and OGTT as screening tests for diabetes among physicians
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