Performance of Fasting Plasma Glucose for Community-based Screening of Undiagnosed Diabetes and Pre-Diabetes in Sub-Saharan Africa

Assefa Mulu Baye ^1,2* Teferi G Fanta ² Suvi Karuranga ³ Ifeyinwa Dorothy Nnakenyi ⁴ Ekenedilichukwu Esther Young ⁵ Colin Palmer ⁶ Ewan Pearson ⁶ Ifeoma Ulasi ^5,7 Adem Dawed ⁶

• ¹ Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
• ² Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
• ³ European society for emergency medicine, Antwerp, Belgium
• ⁴ Department of Chemical Pathology, College of Medicine, University of Nigeria & University of Nigeria Teaching Hospital,, Enugu, Nigeria
• ⁵ Department of Medicine, College of Medicine, University of Nigeria & University of Nigeria Teaching Hospital, Enugu, Nigeria
• ⁶ Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
• ⁷ Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria

Introduction: Accurate Early diabetes diagnosis 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 detecting 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.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 diagnosing 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 diagnosed identified diabetes cases using 2-h PG to be 104.5105 mg/dL associated with a sensitivity and specificity of 67.2% and 94.0%, respectively.FPG was able to correctly identify 99.3% of individuals with no diabetes but Aa 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 104.5105 mg/dL substantially increases the identification of individuals with diabetes, thus improving the effectiveness of FPG as a screening test for type 2 diabetes.