Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis.
Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis.
Blog Article
AimThis systematic review aimed to ascertain the diagnostic accuracy (sensitivity and specificity) of screening tests for early detection of type 2 diabetes and prediabetes in previously undiagnosed adults.MethodsThis systematic review included published studies that included one or more index tests (random and fasting tests, HbA1c) for glucose detection, with 75-gram Oral Glucose Tolerance Test (or 2-hour post load glucose) as a reference standard (PROSPERO ID CRD42018102477).Seven databases were searched electronically (from their inception up to March 9, 2020) accompanied with bibliographic and website searches.Records were manually screened and rembrandt - acquerello stucco full text were selected based on inclusion and exclusion criteria.
Subsequently, data extraction was done using standardized form and quality assessment of studies using QUADAS-2 tool.Meta-analysis was done using bivariate model using Stata 14.0.Optimal cut offs in terms of sensitivity and specificity for the tests were analysed using R software.
ResultsOf 7,151 records assessed by title and abstract, a total of 37 peer reviewed articles were included in this systematic review.The pooled sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-) for diagnosing diabetes with HbA1c (6.5%; venous sample; n = 17 studies) were 50% (95% CI: 42-59%), 97.3% (95% CI: 95.
3-98.4), 18.32 (95% CI: 11.06-30.
53) and 0.51 (95% CI: 0.43-0.60), respectively.
However, the optimal cut-off for diagnosing diabetes in previously undiagnosed adults with HbA1c was estimated as 6.03% with pooled sensitivity of 73.9% (95% CI: fr9967 68-79.1%) and specificity of 87.
2% (95% CI: 82-91%).The optimal cut-off for Fasting Plasma Glucose (FPG) was estimated as 104 milligram/dL (mg/dL) with a sensitivity of 82.3% (95% CI: 74.6-88.
1%) and specificity of 89.4% (95% CI: 85.2-92.5%).
ConclusionOur findings suggest that at present recommended threshold of 6.5%, HbA1c is more specific and less sensitive in diagnosing the newly detected diabetes in undiagnosed population from community settings.Lowering of thresholds for HbA1c and FPG to 6.03% and 104 mg/dL for early detection in previously undiagnosed persons for screening purposes may be considered.