Alpha Omega Alpha Honor Medical Society

2014 Research Abstract

Developing a screening algorithm for type II diabetes in the resource-limited setting of rural Tanzania

Investigator: Caroline West

Mentor: Michael Sweat, PhD

Non-communicable diseases (NCDs) are on pace to outnumber infectious disease as the leading cause of death in sub-Saharan Africa within two decades. Although evidence strongly suggests the prevalence of type II diabetes mellitus (DM2) is increasing in sub-Saharan Africa, there is little research concerning the most effective methods of screening for DM2 in this resource-limited setting. The principle aim of this study is to design a screening algorithm for DM2 that optimizes 1) accuracy of identifying individuals with undiagnosed DM2 and those at high risk for developing DM2, 2) cost on health systems and individuals in a country where 40% of the population lives on less than $1 USD per day, and 3) feasibility in a resource-limited setting with major challenges to primary care. This project is a sub-study of a rigorous, 3-year, NIH R01 Phase II randomized control trial designed to reduce population-level HIV incidence in rural Tanzania. Baseline demographic and biochemical data, including HbA1c, was collected on 710 participants in the rural Kisarawe district of Tanzania. This data was used in mathematical modeling of eight purposed screening algorithms, along with other model parameters obtained from the literature, such as the sensitivity and specificity of available screening modalities. Screening modalities that were used to construct the algorithms include risk assessment questionnaire and measurements for urine glucose, random blood glucose, fasting blood glucose, and HbA1c. Monte Carlo and Latin Hypercube simulation techniques with correlation analysis were used to both optimize the model options and to examine the sensitivity of model parameters. Identification of an optimized screening algorithm for DM2 will be used in the current study, which could eventually bolster efforts of local health systems to better manage the rising prevalence of NCDs in rural Tanzania.

Last updated: 2/20/2014

Updated on February 20, 2015.

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