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Open Access Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin

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Setting: The tuberculosis (TB) clinics of five health facilities in western Kenya.

Objective: To assess the prevalence and associated determinants of diabetes mellitus (DM) and pre-diabetes hyperglycaemia among adult TB patients using point-of-care DCA Vantage glycated haemoglobin (HbA1c) devices.

Design: This was a cross-sectional study.

Results: Of 454 patients, 272 (60%) were males, the median age was 34 years, 175 (39%) were co-infected with the human immunodeficiency virus (HIV), and the median duration of anti-tuberculosis treatment was 8 weeks; 180 (40%) patients reported at least one classical symptom suggestive of DM. The prevalence of DM (HbA1c 6.5%) was 5.1% (95%CI 3.2–7.5), while that of pre-diabetes (HbA1c 5.7–6.4%) was 37.5% (95%CI 33.1–42.2). The number needed to screen (NNS) was 19.6 for DM and 2.7 for pre-diabetes. Combined, 42.6% (95%CI 38.0–47.3) of the patients had either pre-diabetes or DM (NNS 2.3). Seven of the 23 patients with DM knew their prior DM status. Higher rates of DM were associated with age 40 years and a family history of DM, but not obesity, type of TB, HIV status or suggestive symptoms.

Conclusions: High rates of pre-diabetes and DM were found in adult TB patients. This study supports the need for routine screening of all patients with TB for DM in Kenya.
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Keywords: DCA Vantage; HbA1c; operational research; prevalence

Document Type: Research Article

Affiliations: 1: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, International Union Against Tuberculosis and Lung Disease, Paris, France 2: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya 3: International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK 4: Purdue University College of Pharmacy, West Lafayette, Indiana, USA, Moi University School of Medicine, Eldoret, Kenya 5: Ministry of Health, Nairobi, Kenya 6: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, Moi Teaching and Referral Hospital, Eldoret, Kenya 7: Moi Teaching and Referral Hospital, Eldoret, Kenya 8: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, Moi University School of Medicine, Eldoret, Kenya 9: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, Moi University School of Medicine, Eldoret, Kenya, Alpert Medical School, Brown University, Providence, Rhode Island, USA, Indiana University School of Medicine, Bloomington, Indiana, USA

Publication date: June 21, 2017

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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