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Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

James Muchira1, Eileen Stuart-Shor2, Jen Manne-Goehler3,4

  • 11 University of Massachusetts Boston, College of Nursing and Health Sciences, Boston, MA, USA.

International Journal of STD & AIDS
|February 5, 2019
PubMed

Insights

Hemoglobin A1c (A1c) may underestimate diabetes in people living with HIV (PLWH) in Sub-Saharan Africa. A high A1c threshold showed poor sensitivity for diagnosing diabetes in this population.

Area of Science:

  • Global Health
  • Endocrinology
  • Infectious Diseases

Background:

  • Sub-Saharan Africa faces a dual burden of HIV and diabetes.
  • Hemoglobin A1c (A1c) may inaccurately reflect glycemic control in people living with HIV (PLWH).

Purpose of the Study:

  • To assess the diagnostic accuracy of A1c for diabetes in PLWH compared to HIV-uninfected individuals in rural Uganda.
  • To evaluate A1c's validity using fasting blood glucose (FBG) as the reference standard.

Main Methods:

  • A cohort study compared PLWH on antiretroviral therapy with age- and gender-matched HIV-uninfected controls.
  • Pearson correlations and regression models assessed the relationship between A1c and FBG.
  • Sensitivity and specificity of A1c for diagnosing diabetes (FBG ≥126 mg/dL) were calculated.

Main Results:

  • A total of 212 participants (48% female, mean age 51.7 years) were enrolled.
  • No significant differences in mean FBG or A1c were observed between PLWH and HIV-uninfected groups.
  • A1c ≥6.5% demonstrated low sensitivity (46%) but high specificity (98%) for diabetes diagnosis.

Conclusions:

  • The standard A1c threshold of ≥6.5% is insufficient for diagnosing diabetes in PLWH in this SSA setting.
  • Further research is required to establish an optimal A1c cutoff for diabetes screening in Sub-Saharan Africa.
  • The co-epidemic of HIV and diabetes necessitates validated diagnostic tools in SSA.

Keywords:
HIVHemoglobin A1cdiabetesfasting blood glucosesub-Saharan Africa

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