ArticleFrontiers in endocrinology2025
Performance of fasting plasma glucose for community-based screening of undiagnosed diabetes and pre-diabetes in sub-Saharan Africa.
Article in Frontiers in endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Early diabetes screening is critical in sub-Saharan Africa (SSA), where the prevalence is increasing, yet a large proportion of cases remain undiagnosed. This study aimed to evaluate the performance of fasting plasma glucose (FPG) in screening diabetes and/or prediabetes compared to the 2-hour plasma glucose (2-h PG)-level in SSA. Methods: Data from a population-based, cross-sectional diabetes screening survey involving 1550 individuals in Butajira, Ethiopia, and Enugu state, Nigeria were analyzed. Fasting plasma glucose and a 2-hour 75-g oral glucose tolerance test (OGTT) were utilized for diabetes screening. In addition, we determined and plotted the receiver operating characteristic curve for FPG against the reference standard 2-h PG to evaluate the screening tool's sensitivity and specificity. Results: The mean (SD) age of the study participants was 44.5 (± 16.43) years, with men comprising 50.4% of the cohort. Among 1550 individuals analyzed, 4.6% and 16.8% demonstrated diabetes and prediabetes, respectively, as identified by either FPG or 2-h PG. The agreement between FPG and 2-h PG in identifying diabetes and prediabetes was moderate, with kappa statistic of 0.56 (95% CI, 0.51 - 0.61; p<0.0001) for diabetes and 0.45 (95% CI, 0.40 - 0.50; p<0.0001) for prediabetes. FPG failed to detect 34.1% of all prediabetes and 44.4% of all diabetes cases. The sensitivity of FPG in identifying diabetes cases was 44.3% at a cut-off 126 mg/dL with a specificity of 99.3%. We identified the optimal FPG cut-off for detecting newly identified diabetes cases using 2-h PG to be 105 mg/dL associated with a sensitivity and specificity of 67.2% and 94.0%, respectively. Conclusion: FPG was able to correctly identify 99.3% of individuals with no diabetes but a significant percentage of diabetes cases would have remained undiagnosed if only FPG had been utilized instead of the 2-h PG. The use of 2-h PG test is recommended to diagnose diabetes in older individuals, females and non-obese persons who would be missed if tested by only FPG. Lowering the cut-off value for FPG to 105 mg/dL substantially increases the identification of individuals with diabetes, thus improving the effectiveness of FPG as a screening test for type 2 diabetes.
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