Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans

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dc.contributor.authorNguyen, Kim A.en_ZA
dc.contributor.authorPeer, Nasheetaen_ZA
dc.contributor.authorDe Villiers, Annizaen_ZA
dc.contributor.authorMukasa, Barbaraen_ZA
dc.contributor.authorMatsha, Tandi E.en_ZA
dc.contributor.authorMills, Edward J.en_ZA
dc.contributor.authorKengne, Andre P.en_ZA
dc.date.accessioned2021-12-09T07:19:32Z
dc.date.available2021-12-09T07:19:32Z
dc.date.issued2019
dc.descriptionCITATION: Nguyen, K. A., et al. 2019. Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans. PLoS ONE, 14(1):e0211483, doi:10.1371/journal.pone.0211483.
dc.descriptionThe original publication is available at https://journals.plos.org/plosone/
dc.description.abstractBackground: Glycated haemoglobin (HbA1c) test has been increasingly promoted as an alternative to fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) to diagnose dysglycaemia but its performance in HIV-infected Africans has yet to be established. This study aimed to assess the diagnostic accuracy of HbA1c for dysglycaemia including FPG-defined and OGTT-defined dysglycaemia, and OGTT-defined diabetes in HIV-infected Africans, and the effect of HbA1c-predicted dysglycaemia on Joint Interim Statement (JIS)-based prevalent metabolic syndrome (MS). Methods: A cross-sectional study included HIV-positive patients recruited across public healthcare facilities in the Western Cape. The recommended HbA1c cut-points were tested alongside the optimal cut-points obtained from receiver operating characteristic curve analyses, while the agreement between the MS criteria were assessed using kappa statistic. Results: 748 participants (157 men), median age 38 years, 93% on anti-retroviral drugs were included. The optimal HbA1c cut-points of 5.75% (39.3 mmol/mol) showed 54% sensitivity, 84% specificity for FPG-defined dysglycaemia, and 52% sensitivity, 85% specificity for OGTT-defined dysglycaemia. The HbA1c value of 5.85% (40.4 mmol/mol) (63% sensitivity, 99% specificity) was optimal for diabetes. The internationally advocated cut-point of 6.5% (48 mmol/mol) had 37% sensitivity and 99% specificity for diabetes, while HbA1c ≥5.7% (≥39 mmol/mol) yielded similar performance with the study-specific cut-point for any dysglycaemia. MS prevalence by the JIS criteria (28.2%) increased to 29.7% when using HbA1c ≥5.75% (≥39.3 mmol/mol) and to 32.9% with HbA1c ≥5.7% (≥39 mmol/mol); agreement between the original and modified criteria was generally good. Conclusions: This study agrees with the internationally recommended HbA1c cut-point for detecting dysglycaemia, but not for diabetes in HIV-infected Africans. In line with previous studies in general African populations, our findings suggest that similar factors interfere with HbA1c values regardless of HIV infection status. Replacing FPG-based with HbA1c-predicted dysglycaemia in the JIS criteria to diagnose MS is feasible in HIV-infected Africans.en_ZA
dc.description.urihttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211483
dc.description.versionPublisher's version
dc.format.extent11 pages ; illustrations
dc.identifier.citationNguyen, K. A., et al. 2019. Glycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africans. PLoS ONE, 14(1):e0211483, doi:10.1371/journal.pone.0211483
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0211483
dc.identifier.urihttp://hdl.handle.net/10019.1/123544
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectGlycosylated haemoglobin -- Testingen_ZA
dc.subjectBlood sugar -- Analysisen_ZA
dc.subjectBlood sugar monitoringen_ZA
dc.subjectMetabolic Syndromeen_ZA
dc.subjectAfricansen_ZA
dc.subjectHIV-positive personsen_ZA
dc.titleGlycated haemoglobin threshold for dysglycaemia screening, and application to metabolic syndrome diagnosis in HIV-infected Africansen_ZA
dc.typeArticleen_ZA
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