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. 2021 Dec 3;16(1):79.
doi: 10.5334/gh.1083. eCollection 2021.

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

Stephen Olivier  1 , Thomas Murray  1 , Philippa Matthews  1   2 , Ngcebo Mhlongo  1 , Resign Gunda  1 , Kathy Baisley  1   3 , Dickman Gareta  1 , Tshwaraganang Modise  1 , Theresa Smit  1 , Kobus Herbst  1   4 , Xolile Mpofana  1 , Thumbi Ndung'u  1   5   6   7 , Olivier Koole  1   3 , Deenan Pillay  1   7 , Willem Hanekom  1   7 , Emily Wong  1   8 , Mark J Siedner  1   9 ; Vukuzazi Study team
Affiliations

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

Stephen Olivier et al. Glob Heart. .

Abstract

Background: Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, 'Vukuzazi' in rural South Africa.

Methods: We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value.

Results: Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed.

Conclusions: A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations.

Keywords: Diabetes; Screening; hypertension.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Flow diagram of participants included in the analysis with initial and repeated elevated measures of blood pressure and HbA1c.
Figure 2
Figure 2
Distribution and correlation of blood pressure and HbA1c with blood glucose measures done at initial screening and confirmatory follow-up visit.
Figure 3
Figure 3
Predictions from a logistic regression model of the relationship between initial blood pressure and HbA1c glucose and the probability of having elevated blood pressure or blood glucose during the confirmatory follow-up visit.
See this image and copyright information in PMC

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