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Choo M, Hoy GE, Dugan SP, McEwen LN, Gunaratnam N, Wyckoff J, Jeevaraaj T, Saththiyaseelan A, Ganeikabahu B, Katulanda P, Balis U, Herman WH, Saha AK. Imputing HbA1c from capillary blood glucose levels in patients with type 2 diabetes in Sri Lanka: a cross-sectional study. BMJ Open 2020; 10:e038148. [PMID: 32690534 PMCID: PMC7371026 DOI: 10.1136/bmjopen-2020-038148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop a population-specific methodology for estimating glycaemic control that optimises resource allocation for patients with diabetes in rural Sri Lanka. DESIGN Cross-sectional study. SETTING Trincomalee, Sri Lanka. PARTICIPANTS Patients with non-insulin-treated type 2 diabetes (n=220) from three hospitals in Trincomalee, Sri Lanka. OUTCOME MEASURE Cross-validation was used to build and validate linear regression models to identify predictors of haemoglobin A1c (HbA1c). Validation of models that regress HbA1c on known determinants of glycaemic control was thus the major outcome. These models were then used to devise an algorithm for categorising the patients based on estimated levels of glycaemic control. RESULTS Time since last oral intake other than water and capillary blood glucose were the statistically significant predictors of HbA1c and thus included in the final models. In order to minimise type II error (misclassifying a high-risk individual as low-risk or moderate-risk), an algorithm for interpreting estimated glycaemic control was created. With this algorithm, 97.2% of the diabetic patients with HbA1c ≥9.0% were correctly identified. CONCLUSIONS Our calibrated algorithm represents a highly sensitive approach for detecting patients with high-risk diabetes while optimising the allocation of HbA1c testing. Implementation of these methods will optimise the usage of resources devoted to the management of diabetes in Trincomalee, Sri Lanka. Further external validation with diverse patient populations is required before applying our algorithm more widely.
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Affiliation(s)
- Monica Choo
- University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Gregory E Hoy
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Medical Scientist Training Program, University of Michigan, Ann Arbor, MI, United States
| | - Sarah P Dugan
- University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Laura N McEwen
- Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Naresh Gunaratnam
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Huron Gastroenterology Associates, Ypsilanti, Michigan, United States
- The Grace Girls' Home, Trincomalee, Sri Lanka
| | - Jennifer Wyckoff
- Internal Medicine - Metabolism, Endocrinology, and Diabetes, Michigan Medicine, Ann Arbor, MI, United States
| | | | | | - B Ganeikabahu
- Trincomalee General Hospital, Trincomalee, Sri Lanka
| | - Prasad Katulanda
- Clinical Medicine, University of Colombo, Colombo, Western, Sri Lanka
| | - Ulysses Balis
- Pathology - Informatics, Michigan Medicine, Ann Arbor, Michigan, United States
| | - William H Herman
- Internal Medicine - Metabolism, Endocrinology, and Diabetes, Michigan Medicine, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Anjan K Saha
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Medical Scientist Training Program, University of Michigan, Ann Arbor, MI, United States
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Ranasinghe P, Jayawardena R, Katulanda P. The facts, figures, and reality of the diabetes epidemic in Sri Lanka: a systematic review. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0326-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dissanayake A, Idampitiya CA, Amarasinghe A, Thomson GA, Fernando DJS. Capacity building through research and educational collaboration: a report of a UK–Sri Lanka collaboration. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdi.1008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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