Performance of fasting plasma glucose for community-based screening of undiagnosed diabetes and pre-diabetes in sub-Saharan Africa.
Level 4 - case-series / case-control
Cross-sectional diagnostic accuracy study without a separate prospective validation cohort
PubMed 40206599 · doi:10.3389/fendo.2025.1501383
What was done
Researchers analyzed data from a population-based, cross-sectional screening survey of 1,550 individuals (mean age 44.5 ± 16.43 years; 50.4% men) across Butajira, Ethiopia, and Enugu state, Nigeria. The diagnostic performance of fasting plasma glucose (FPG) for detecting diabetes and prediabetes was compared against the 2-hour 75-g oral glucose tolerance test (2-h PG) reference standard using receiver operating characteristic curves, sensitivity, specificity, and kappa statistics.
What was found
Using either test, diabetes and prediabetes prevalence were 4.6% and 16.8%, respectively. Agreement between FPG and 2-h PG was moderate (kappa 0.56, 95% CI 0.51–0.61 for diabetes; kappa 0.45, 95% CI 0.40–0.50 for prediabetes). Standard FPG (126 mg/dL cut-off) missed 44.4% of diabetes cases and 34.1% of prediabetes cases, showing 44.3% sensitivity and 99.3% specificity. An optimal FPG cut-off of 105 mg/dL increased sensitivity to 67.2% with 94.0% specificity.
Why it matters
Standard fasting glucose thresholds miss nearly half of individuals with diabetes in sub-Saharan African community settings. Lowering screening cut-offs or using oral glucose tolerance tests may significantly improve detection rates.
Limits
The study is cross-sectional and based on single-visit assessments without repeat confirmatory testing. Data come from two specific regions in Ethiopia and Nigeria, which may not represent all sub-Saharan populations, and performance against HbA1c was not evaluated.
Cited by
- supports Fasting glucose testing misses more than half of prediabetes and diabetes cases.