scholarly journals SUN-616 Poor Diagnostic Concordance Between Fasting Plasma Glucose and Glycosylated Hemoglobin in a Black South African Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alisha N Wade ◽  
Nigel Crowther ◽  
F Xavier Gomez-Olive ◽  
Ryan G Wagner ◽  
Jennifer Manne-Goehler ◽  
...  
Keyword(s):  
South African ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Glycosylated Hemoglobin ◽  
Kappa Statistic ◽  
African Population ◽  
South African Population ◽  
Black South African ◽  
Fasting Plasma ◽  
History Of

Abstract Background: While elevations in fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) are both recognized by the American Diabetes Association (ADA) as diagnostic of hyperglycemia, previous comparisons of these tests have demonstrated discordant individual classifications and population estimates. This may be due to additional postprandial glycemia reflected by HbA1c and, in African-descent populations, to non-glycemic factors that contribute to higher HbA1c at any given level of glycemia. We hypothesized that glycemic classifications based on FPG or HbA1c would differ in a Black South African population and investigated factors associated with discordance. Methods: 889 Black adults with previously undiagnosed diabetes, aged 40-79 years, from the population-based Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) cohort were included. Concordance between ADA FPG (normoglycemia [NG] <100 mg/dl, prediabetes [pre-DM] 100-125 mg/dl, diabetes [DM] ≥ 126 mg/dl) and HbA1c (NG <5.7%, pre-DM 5.7-6.4%, DM ≥ 6.5%) classifications was assessed using Cohen’s kappa statistic and logistic regression models were used to identify predictors of discordance. Results: Median age was 55 years (IQR 49-62) and 49.3% of the sample was male. Median glucose was 86.4 mg/dl and median HbA1c was 5.4%. Pre-DM, as defined by HbA1c, was present in 204 participants (22.9%), while FPG-defined pre-DM was present in 122 (13.7%). DM defined by HbA1c was present in 146 (16.4%), while FPG-defined DM was present in 36 (4.0%). Concordance between the two tests was poor (kappa statistic 0.18; 95%CI 0.13-0.24). Self-reported history of tuberculosis (OR 1.90, p=0.026) and higher HbA1c (OR 4.70, p<0.001) were associated with increased likelihood of discordance, whereas higher fasting glucose was associated with decreased likelihood of discordance (OR 0.58, p<0.001). There was no association between discordance and hemoglobin, HIV status, BMI, waist circumference or hip circumference. Conclusion: FPG and HbA1c exhibit poor concordance in classifying hyperglycemia in this Black South African population, with HbA1c-based definitions identifying higher prevalences of pre-DM and DM. Further work is needed to confirm whether these discrepancies are due solely to elevations in postprandial glucose. In the interim, clinicians should consider confirming elevated HbA1c concentrations with oral glucose tolerance testing, particularly in those with a history of tuberculosis, prior to making a diagnosis of DM in this population.

scholarly journals Concordance between fasting plasma glucose and HbA1c in the diagnosis of diabetes in black South African adults: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046060
Author(s):  
Alisha N Wade ◽  
Nigel J Crowther ◽  
Shafika Abrahams-Gessel ◽  
Lisa Berkman ◽  
Jaya A George ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
South African ◽  
Plasma Glucose ◽  
Fat Distribution ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
South African Population ◽  
Cross Sectional ◽  
Black South African

ObjectivesWe investigated concordance between haemoglobin A1c (HbA1c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity.DesignCross-sectional study.SettingRural South African population-based cohort.Participants765 black individuals aged 40–70 years and with no history of diabetes.Primary and secondary outcome measuresThe primary outcome measure was concordance between HbA1c-defined diabetes and FPG-defined diabetes. Secondary outcome measures were differences in anthropometric characteristics, fat distribution and insulin resistance (measured using Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR)) between those with concordant and discordant HbA1c/FPG classifications and predictors of HbA1c variance.ResultsThe prevalence of HbA1c-defined diabetes was four times the prevalence of FPG-defined diabetes (17.5% vs 4.2%). Classification was discordant in 15.7% of participants, with 111 individuals (14.5%) having HbA1c-only diabetes (kappa 0.23; 95% CI 0.14 to 0.31). Median body mass index, waist and hip circumference, waist-to-hip ratio, subcutaneous adipose tissue and HOMA-IR in participants with HbA1c-only diabetes were similar to those in participants who were normoglycaemic by both biomarkers and significantly lower than in participants with diabetes by both biomarkers (p<0.05). HOMA-IR and fat distribution explained additional HbA1c variance beyond glucose and age only in women.ConclusionsConcordance was poor between HbA1c and FPG in diagnosis of diabetes in black South Africans, and participants with HbA1c-only diabetes phenotypically resembled normoglycaemic participants. Further work is necessary to determine which of these parameters better predicts diabetes-related morbidities in this population and whether a population-specific HbA1c threshold is necessary.

scholarly journals Genetic factors influencing bone mineral content in a black South African population

2013 ◽  
Vol 31 (6) ◽  
pp. 708-716 ◽  
Author(s):  
Andrew May ◽  
John M. Pettifor ◽  
Shane A. Norris ◽  
Michèle Ramsay ◽  
Zané Lombard
Keyword(s):  
Bone Mineral Content ◽  
South African ◽  
Bone Mineral ◽  
Mineral Content ◽  
Genetic Factors ◽  
African Population ◽  
South African Population ◽  
Black South African ◽  
Factors Influencing

scholarly journals A comparison of the visual status of dyslexic and non-dyslexic schoolchildren in Durban, South Africa

2011 ◽  
Vol 70 (1) ◽  
Author(s):  
S. O. Wajuihian ◽  
K. S. Naidoo
Keyword(s):  
South African ◽  
Educational Achievement ◽  
Economic Status ◽  
African Population ◽  
South African Population ◽  
Research Perspective ◽  
Black South African ◽  
Visual Status ◽  
Lag Of Accommodation ◽  
Vision Defects

Background:   Reading difficulties constitute an impediment to the learning process and in the educational achievement of a child. Consequently, several studies examined the visual status of dyslexic children in the Caucasian populations. Such studies are lacking in the African populations.Aim: To determine the prevalence of vision defects and investigate if there is an association between dyslexia and vision in a South African population of dyslexic school children.  Methods:  This comparative study assessed the visual function of 62 children (31 dyslexic and 31 normally-reading children), mean age 13 ± 1.42 years and 11.90 ± 0.93 years respectively. The participants were matched for gender, race and socio-economic status. The visual functions evaluated and the techniques used were: visual acuity (LogMAR acuity chart), refraction (static retinos-copy), ocular alignment (cover test) near point of convergence (RAF rule), accommodation facility (± 2 D flipper lenses), amplitude of accommodation (push-up method) relative accommodation(trial lenses) accommodation posture (monocular estimation technique) and vergence reserves (prism bars). Results:   In the following, results are  provided for the dyslexic versus control:  Refractive errors: (hyperopia 6.5% vs 3%,) (myopia 6.5% vs 6.5%), (astigmatism 10% vs 13%), (anisometropia 6.5% vs 6.5%) (amblyopia 6.5% vs 0%), (remote NPC 33% vs 48%) (esophoria at near 3%  vs 0%) (exophoria at near 9.5% vs 0%), (accommodative infacility at near  54% vs 33%), lag of accommodation 39.28% vs 41,93%,  (poor positive fusional amplitude at near, 25% vs 16%). Only the binocular accommodative facility at near was significantly associated with dyslexia (p=0.027). Conclusion: The prevalence of vision defects was similar between the dyslexic and non-dyslexic participants, which suggest that an association between dyslexia and vision variables investigated, cannot be inferred.  This study provides a research perspective on the prevalence of vision defects in a Black South African population of dyslexic children and has clinical relevance and implications for the assessment, detection and management of vision anomalies in dyslexic schoolchildren. (S Afr Optom 2011 70(1) 29-43) 

scholarly journals Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial

2017 ◽  
Vol 117 (6) ◽  
pp. 804-813 ◽  
Author(s):  
Kristin L. Wickens ◽  
Christine A. Barthow ◽  
Rinki Murphy ◽  
Peter R. Abels ◽  
Robyn M. Maude ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
International Association ◽  
Controlled Trial ◽  
Lactobacillus Rhamnosus ◽  
Fasting Plasma ◽  
History Of

AbstractThe study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 (HN001) can reduce the prevalence of gestational diabetes mellitus (GDM). A double-blind, randomised, placebo-controlled parallel trial was conducted in New Zealand (NZ) (Wellington and Auckland). Pregnant women with a personal or partner history of atopic disease were randomised at 14–16 weeks’ gestation to receive HN001 (6×109 colony-forming units) (n 212) or placebo (n 211) daily. GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (fasting plasma glucose ≥5·1 mmol/l, or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l) and NZ definition (fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l). All analyses were intention-to-treat. A total of 184 (87 %) women took HN001 and 189 (90 %) women took placebo. There was a trend towards lower relative rates (RR) of GDM (IADPSG definition) in the HN001 group, 0·59 (95 % CI 0·32, 1·08) (P=0·08). HN001 was associated with lower rates of GDM in women aged ≥35 years (RR 0·31; 95 % CI 0·12, 0·81, P=0·009) and women with a history of GDM (RR 0·00; 95 % CI 0·00, 0·66, P=0·004). These rates did not differ significantly from those of women without these characteristics. Using the NZ definition, GDM prevalence was significantly lower in the HN001 group, 2·1 % (95 % CI 0·6, 5·2), v. 6·5 % (95 % CI 3·5, 10·9) in the placebo group (P=0·03). HN001 supplementation from 14 to 16 weeks’ gestation may reduce GDM prevalence, particularly among older women and those with previous GDM.

Relationship Between Fasting Plasma Glucose and Glycosylated Hemoglobin

JAMA ◽  
1999 ◽  
Vol 281 (13) ◽  
pp. 1203 ◽  
Author(s):  
Mayer B. Davidson ◽  
David L. Schriger ◽  
Anne L. Peters ◽  
Brett Lorber
Keyword(s):  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Glycosylated Hemoglobin ◽  
Fasting Plasma

Genetic variants inCYP(-1A2,-2C9,-2C19,-3A4and-3A5),VKORC1andABCB1genes in a black South African population: a window into diversity

2011 ◽  
Vol 12 (12) ◽  
pp. 1663-1670 ◽  
Author(s):  
Collet Dandara ◽  
Zané Lombard ◽  
Ingrid Du Plooy ◽  
Tracy McLellan ◽  
Shane A Norris ◽  
...  
Keyword(s):  
South African ◽  
Genetic Variants ◽  
African Population ◽  
South African Population ◽  
Black South African

scholarly journals Multimorbidity and mortality in an older, rural black South African population cohort with high prevalence of HIV findings from the HAALSI Study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047777
Author(s):  
Alisha N Wade ◽  
Collin F Payne ◽  
Lisa Berkman ◽  
Angela Chang ◽  
F Xavier Gómez-Olivé ◽  
...  
Keyword(s):  
South African ◽  
Mortality Risk ◽  
Outcome Measure ◽  
African Population ◽  
Secondary Outcome ◽  
South African Population ◽  
Black South African ◽  
Risk Of Death ◽  
Population Cohort ◽  
The Relationship

ObjectivesMultimorbidity is associated with mortality in high-income countries. Our objective was to investigate the relationship between multimorbidity (≥2 of the following chronic medical conditions: hypertension, diabetes, dyslipidaemia, anaemia, HIV, angina, depression, post-traumatic stress disorder, alcohol dependence) and all-cause mortality in an older, rural black South African population. We further investigated the relationship between HIV multimorbidity (HIV as part of the multimorbidity cluster) and mortality, while testing for the effect of frailty in all models.DesignPopulation cohort study.SettingAgincourt subdistrict of Mpumalanga province, South Africa.Participants4455 individuals (54.7% female), aged ≥40 years (median age 61 years, IQR 52–71) and resident in the study area.Primary and secondary outcome measuresThe primary outcome measure was time to death and the secondary outcome measure was likelihood of death within 2 years of the initial study visit. Mortality was determined during annual population surveillance updates.Results3157 individuals (70.9%) had multimorbidity; 29% of these had HIV. In models adjusted for age and sociodemographic factors, multimorbidity was associated with greater risk of death (women: HR 1.72; 95% CI: 1.18 to 2.50; men: HR 1.46; 95% CI: 1.09 to 1.95) and greater odds of dying within 2 years (women: OR 2.34; 95% CI: 1.32 to 4.16; men: OR 1.51; 95% CI: 1.02 to 2.24). HIV multimorbidity was associated with increased risk of death compared with non-HIV multimorbidity in men (HR 1.93; 95% CI: 1.05 to 3.54), but was not statistically significant in women (HR 1.85; 95% CI: 0.85 to 4.04); when detectable, HIV viral loads were higher in men (p=0.021). Further adjustment for frailty slightly attenuated the associations between multimorbidity and mortality risk (women: HR 1.55; 95% CI: 1.06 to 2.26; men: HR 1.36; 95% CI: 1.01 to 1.82), but slightly increased associations between HIV multimorbidity and mortality risk.ConclusionsMultimorbidity is associated with mortality in this older black South African population. Health systems which currently focus on HIV should be reorganised to optimise identification and management of other prevalent chronic diseases.

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