Dataset Information

Diagnostic accuracy of self-administered urine glucose test strips as a diabetes screening tool in a low-resource setting in Cambodia.

ABSTRACT:

Objective

Screening for diabetes in low-resource countries is a growing challenge, necessitating tests that are resource and context appropriate. The aim of this study was to determine the diagnostic accuracy of a self-administered urine glucose test strip compared with alternative diabetes screening tools in a low-resource setting of Cambodia.

Design

Prospective cross-sectional study.

Setting

Members of the Borey Santepheap Community in Cambodia (Phnom Penh Municipality, District Dangkao, Commune Chom Chao).

Participants

All households on randomly selected streets were invited to participate, and adults at least 18 years of age living in the study area were eligible for inclusion.

Outcomes

The accuracy of self-administered urine glucose test strip positivity, Hemoglobin A1c (HbA1c)>6.5% and capillary fasting blood glucose (cFBG) measurement ?126?mg/dL were assessed against a composite reference standard of cFBGmeasurement ?200?mg/dL or venous blood glucose 2?hours after oral glucose tolerance test (OGTT) ?200?mg/dL.

Results

Of the 1289 participants, 234 (18%) had diabetes based on either cFBG measurement (74, 32%) or the OGTT (160, 68%). The urine glucose test strip was 14% sensitive and 99% specific and failed to identify 201 individuals with diabetes while falsely identifying 7 without diabetes. Those missed by the urine glucose test strip had lower venous fasting blood glucose, lower venous blood glucose 2?hours after OGTT and lower HbA1c compared with those correctly diagnosed.

Conclusions

Low cost, easy to use diabetes tools are essential for low-resource communities with minimal infrastructure. While the urine glucose test strip may identify persons with diabetes that might otherwise go undiagnosed in these settings, its poor sensitivity cannot be ignored. The massive burden of diabetes in low-resource settings demands improvements in test technologies.

SUBMITTER: Storey HL

PROVIDER: S-EPMC5875619 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

Diagnostic accuracy of self-administered urine glucose test strips as a diabetes screening tool in a low-resource setting in Cambodia.

Storey Helen L HL van Pelt Maurits H MH Bun Socheath S Daily Frances F Neogi Tina T Thompson Matthew M McGuire Helen H Weigl Bernhard H BH

BMJ open 20180322 3

<h4>Objective</h4>Screening for diabetes in low-resource countries is a growing challenge, necessitating tests that are resource and context appropriate. The aim of this study was to determine the diagnostic accuracy of a self-administered urine glucose test strip compared with alternative diabetes screening tools in a low-resource setting of Cambodia.<h4>Design</h4>Prospective cross-sectional study.<h4>Setting</h4>Members of the Borey Santepheap Community in Cambodia (Phnom Penh Municipality, D ...[more]

PMID: 29567849

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Project description:BackgroundThe prevalence of chronic kidney disease (CKD) is predicted to rise over the next few decades. In resource-limited settings access to central laboratory services is limited. Point-of-care (POC) urine dipstick testing offers the potential to detect markers of kidney damage (albuminuria) as well as markers of other disease processes. We evaluated the diagnostic accuracy of the semi-quantitative albumin-creatinine ratio (ACR) Sysmex UC-1000 POC urine dipstick system as well as the extent of other abnormal dipstick findings in urine.Methods700 participants from a rural area in South Africa were screened for albuminuria. A spot urine sample was used to measure POC and central laboratory ACR. We determined the sensitivity, specificity, positive predictive value and negative predictive value of the POC ACR, and recorded dipstick parameters.ResultsThe prevalence of albuminuria was 11.6% (95%CI; 9.3-14.2). Those with albuminuria had higher mean diastolic (82 vs 79 mmHg, p = 0.019) and systolic (133 vs 128 mmHg, p = 0.002) blood pressures and a higher proportion of diabetes mellitus (17.6 vs 4.9%, p < 0.001). The sensitivity of the POC ACR system was 0.79, specificity 0.84, positive predictive value 0.39 and negative predictive value 0.97. The sensitivity improved to 0.80, 0.85, 0.85 and 0.89 in those with elevated blood pressure, diabetes mellitus, HIV positive status, and those 65 years and older, respectively. Abnormalities other than albuminuria were detected in 240 (34.3%) of the samples; 88 (12.6%) were positive for haematuria, 113 (16.1%) for leucocytes, 66 (9.4%) for nitrites and 27 (3.9%) for glycosuria.ConclusionOur study shows that POC ACR has good negative predictive value and could be used to rule out albuminuria when screening for CKD. Additionally, a high proportion of participants had other urine abnormalities detected with dipsticks which may reflect kidney disease or co-morbid untreated genitourinary pathology such as urinary tract infections or endemic schistosomiasis with important implications for CKD.

Project description:BackgroundIndividual patient data meta-analyses (IPD-MA) are regarded as the gold standard for systematic reviews, which also applies to systematic reviews of diagnostic test accuracy (DTA) studies. An increasing number of DTA systematic reviews with IPD-MA have been published in recent years, but there is much variation in how these IPD-MA were performed. A number of existing methods were found, but there is no consensus as to which methods are preferred as the standard methods for statistical analysis in DTA IPD-MA.ObjectivesTo create a web-based tool which integrates recommended statistical analyses for DTA IPD-MA, and allows researchers to analyse the data and visualize the results with interactive plots.MethodsA systematic methodological review was performed to identify statistical analyses and data visualization methods used in DTA IPD-MA. Methods were evaluated by the authors and recommended analyses were integrated into the IPDmada tool which is freely available online with the user interface developed with R Shiny package.ResultsIPDmada allows users to upload their own data, perform the meta-analysis with both continuous and dichotomized tests, and incorporate individual level covariate-adjusted analysis. All tables and figures can be exported as .csv or .pdf files. A hypothetical dataset was used to illustrate the application of IPDmada.ConclusionsIPDmada will be very helpful to researchers doing DTA IPD-MA, since it not only facilitates the statistical analysis but also provides a standard framework. The introduction of IPDmada will harmonize the methods used in DTA IPD-MA and ensure the quality of such analyses.HighlightsIPDmada is a newly developed web-based tool for performing statistical analysis of individual patient data meta-analysis of diagnostic accuracy and visualizing the results. The tool is freely available to all the researchers, and requiring no installation of statistical software/packages. The tool has an user-friendly interface, and allows meta-analysis on both dichotomized and continuous test results. Researchers can easily use this tool to investigate the threshold effect and covariate effect on the summary accuracy. The introduction and implementation of IPDmada will serve as a useful tool for DTA IPD-MA and increase the quality of such studies.

Dataset Information

Diagnostic accuracy of self-administered urine glucose test strips as a diabetes screening tool in a low-resource setting in Cambodia.

Objective

Design

Setting

Participants

Outcomes

Results

Conclusions

Publications

Diagnostic accuracy of self-administered urine glucose test strips as a diabetes screening tool in a low-resource setting in Cambodia.

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