PMID- 22583817
OWN - NLM
STAT- MEDLINE
DCOM- 20121018
LR  - 20221207
IS  - 1471-2458 (Electronic)
IS  - 1471-2458 (Linking)
VI  - 12
DP  - 2012 May 14
TI  - Use of glucometer and fasting blood glucose as screening tools for diabetes 
      mellitus type 2 and glycated haemoglobin as clinical reference in rural community 
      primary care settings of a middle income country.
PG  - 349
LID - 10.1186/1471-2458-12-349 [doi]
AB  - BACKGROUND: Thailand is considered to be a middle income country, and to control 
      and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the 
      Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM 
      patients has been integrated into the primary health care system, especially in 
      rural areas. The intention of this investigation is to link public health 
      research at the academic level with the local health authorities of a district of 
      a north-eastern province of the country. METHODS: Epidemiological methods were 
      applied to validate the screening tools fasting capillary blood glucose (CBG), 
      measured by glucometer and venous blood for the determination of plasma glucose 
      (VPG), used for screening for T2DM among asymptomatic villagers. For assessing 
      the validity of these two methods glycated haemoglobin (HbA1c) values were 
      determined and used as the 'clinical reference'. RESULTS: All together 669 
      villagers were investigated. Determinations of CBG and VPG resulted in suspected 
      T2DM cases, with 7.3% when assessed by CBG and 6.4% by VPG using a cutoff point 
      of 7 mmol/L (126 mg/dl). Taking HbA1c determinations with a cutoff point of 7% 
      into account, the proportion of T2DM suspected participants increased to 10.4%. 
      By estimating sensitivity, specificity and the positive predictive value of CBG 
      and VPG against the 'clinical reference' of HbA1c, sensitivity below 50% for both 
      screening methods has been observed. The positive predictive value was determined 
      to be 58.5% for CBG and 56.8% for VPG. The specificity of the two screening tests 
      was over 96%. CONCLUSIONS: The low sensitivity indicates that using fasting CBG 
      or VPG as a screening tool in the field results in a high proportion of diseased 
      individuals remaining undetected. The equally low positive predictive values 
      (below 60%) indicate a high working load for the curative sector in investigating 
      suspected T2DM cases to determine whether they are truly diseased or false 
      positive cases according to the screening method. Further implications of the 
      results and the controversial discussion related to the use of HbA1c as clinical 
      evidence for suffering from T2DM are also discussed.
FAU - Muktabhant, Benja
AU  - Muktabhant B
AD  - Department of Nutrition, Faculty of Public Health, Khon Kaen University, Khon 
      Kaen 40002, Thailand.
FAU - Sanchaisuriya, Pattara
AU  - Sanchaisuriya P
FAU - Sarakarn, Pongdech
AU  - Sarakarn P
FAU - Tawityanon, Worawitaya
AU  - Tawityanon W
FAU - Trakulwong, Mantana
AU  - Trakulwong M
FAU - Worawat, Songsri
AU  - Worawat S
FAU - Schelp, Frank P
AU  - Schelp FP
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120514
PL  - England
TA  - BMC Public Health
JT  - BMC public health
JID - 100968562
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Glucose/*analysis
MH  - Blood Glucose Self-Monitoring/instrumentation
MH  - Catchment Area, Health/statistics & numerical data
MH  - Diabetes Mellitus, Type 2/blood/*diagnosis/epidemiology
MH  - Female
MH  - Glucose Tolerance Test/*statistics & numerical data
MH  - Glycated Hemoglobin/*analysis
MH  - Humans
MH  - Male
MH  - Mass Screening/*methods
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Primary Health Care
MH  - ROC Curve
MH  - Rural Population
MH  - Sensitivity and Specificity
MH  - Social Class
MH  - Thailand/epidemiology
PMC - PMC3403882
EDAT- 2012/05/16 06:00
MHDA- 2012/10/19 06:00
PMCR- 2012/05/14
CRDT- 2012/05/16 06:00
PHST- 2011/07/29 00:00 [received]
PHST- 2012/05/14 00:00 [accepted]
PHST- 2012/05/16 06:00 [entrez]
PHST- 2012/05/16 06:00 [pubmed]
PHST- 2012/10/19 06:00 [medline]
PHST- 2012/05/14 00:00 [pmc-release]
AID - 1471-2458-12-349 [pii]
AID - 10.1186/1471-2458-12-349 [doi]
PST - epublish
SO  - BMC Public Health. 2012 May 14;12:349. doi: 10.1186/1471-2458-12-349.