Is there a role for glycosuria testing in sub-Saharan Africa?
BACKGROUND
With increasing urbanization and westernization, rates of diabetes in sub-Saharan Africa (sSA) are likely to rise. Early detection and intervention plays an important role in delaying development of complications. In sSA in particular there is need for an affordable, reliable, safe, feasible test to avert human suffering and exhausting already stressed health facilities.


METHODS
Data from two large community-based studies were used to assess the value of glycosuria testing in the detection of diabetes in adults in a sub-Saharan country. A first study (A) tested participants for glycosuria by dipstick; if positive, fasting capillary glucose was measured. A later study (B) measured glucose concentration in venous blood 2 h after a 75-g glucose load; if glycaemia was > or = 10 mmol/l, urine was tested for glycosuria.


RESULTS
The positive predictive value of glycosuria for a diagnosis of diabetes (fasting glucose > or = 6.7 mmol/l) was 48%. Sensitivity was 64% (57% if a 2-h-value > or = 10 mmol/l was used as gold standard). Sensitivity was higher among overweight and/or hypertensive subjects, among elderly people in the urban area, and among subjects with higher blood glucose levels. Extrapolated specificity was 99.7%, and the likelihood ratio 190.


CONCLUSIONS
Glycosuria testing can identify a considerable number of undiagnosed diabetic patients when specially targeted at high-risk groups (obese, hypertensive, or elderly people). Dipstick glycosuria testing is an appropriate, safe, feasible test for sSA, where the prevalence of diabetes is expected to increase considerably in the near future.
van der Sande
M A
MA
Medical Research Council Laboratories, Fajara, The Gambia.
Walraven
G E
GE
Bailey
R
R
Rowley
J T
JT
Banya
W A
WA
Nyan
O A
OA
Faal
H
H
Ceesay
S M
SM
Milligan
P J
PJ
McAdam
K P
KP
D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005069:Evaluation Studies as Topic; D005215:Fasting; D005260:Female; D005714:Gambia; D006029:Glycosuria / Q000175:diagnosis*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D001786:Blood Glucose