The diagnostic accuracy of HbA_1c, compared to the oral glucose tolerance test, for screening for type 2 diabetes mellitus in Africa — A systematic review and meta-analysis

Chivese, T., Hirst, J., Matizanadzo, J.T., Custodio, M., Farmer, A., Norris, S. and Levitt, N. (2022) The diagnostic accuracy of HbA_1c, compared to the oral glucose tolerance test, for screening for type 2 diabetes mellitus in Africa — A systematic review and meta-analysis. Diabetic Medicine, 39 (4), [e14754]. (doi:10.1111/dme.14754).

Abstract

Objective
To assess the diagnostic accuracy of glycated haemoglobin A1c (HbA1c), compared to fasting plasma glucose (FPG) and the oral glucose tolerance test (OGTT), in screening for type 2 diabetes (T2D) in Africa.

Methods
We systematically searched databases for studies that compared the HbA1c to either the OGTT, or the FPG for T2D diagnosis were included. The QUADAS 2 tool was used for assessing the quality of included studies. We used the split component synthesis (SCS) method for the meta-analysis of diagnostic accuracy studies to pool the studies for meta-analysis of sensitivity and specificity, primarily at the HbA1c ≥48 mmol/mol (6.5%) cut-off and at other cut-offs. We assessed heterogeneity using the I2 statistic and publication bias using Doi plots.

Results
Eleven studies, from seven African countries, with 12,925 participants, were included. Against the OGTT, HbA1c ≥48 mmol/mol (6.5%) had a pooled sensitivity of 57.7% (95% confidence interval [CI] 43.4–70.9) and specificity of 92.3% (95% CI 83.9–96.5). Against the FPG, HbA1c ≥48 mmol/mol (6.5%) had a pooled sensitivity of 64.5% (95% CI 50.5–76.4) and specificity of 94.3% (95% CI 87.9–97.5). The highest sensitivity for HbA1c, against the OGTT, was at the 42 mmol/mol (6.0%) cut-off.

Conclusion
In Africa, the HbA1c ≥48 mmol/mol (6.5%) cut-off may miss almost half of the individuals with T2D based on blood glucose measures.

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Contributors

Author: S. Norris

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