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

作者：Storey Helen L; van Pelt Maurits H; Bun Socheath; Daily Frances; Neogi Tina; Thompson Matthew; McGuire Helen^*; Weigl Bernhard H

来源：BMJ Open, 2018, 8(3): e019924.

DOI：10.1136/bmjopen-2017-019924

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 >= 126mg/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 irnprovernents in test technologies.

• 出版日期2018-3