Diabetes Screening Using a Quantitative Urine Glucose Method

Abstract

Sensitivity and specificity of three methods (random urine glucose (RUG) > 25 mg. per deciliter; positive Clinitest; and random plasma glucose (RPG) > 140, > 120, and > 100 mg. per deciliter) for detecting the unknown diabetic were compared. In 1,952 screenees, RUG of 96.7 per cent was 3 to 25 mg. per deciliter (normoglucosuria), RUG of 2.0 per cent was 26 to 100 mg. per deciliter (moderate hyperglucosuria), and of 1.3 per cent was > 100 mg. per deciliter (marked hyperglucosuria). Twenty-five randomly selected from each of the first two groups and 18 from the third group had a glucose tolerance test (GTT); seven in the third group had fasting plasma glucose tests > 150 mg. per deciliter. GTTs were evaluated by United States Public Health Service (USPHS), Fajans-Conn (F-C), and summation (S) criteria, and tested screenees divided into nondiabetic (ND) and diabetic (DM). NDs with RUG > 25 mg. per deciliter were false positive screens: renal hyperglucosurics (RHG) if GTT urine glucose ^ 80 mg. per deciliter, nonrenal hyperglucosurics (NRHG) if GTT urine glucose *£ 25 mg. per deciliter. The prevalence of DM was 1.24 per cent (USPHS), 1.37 per cent (F-C), and 1.45 per cent (S). The prevalence of false positives (USPHS) was 2.04 per cent (1.19 per cent RHG and 0.85 per cent NRHG). In the normogluco. uria group, 100 per cent who had a GTT were true negatives. In the moderate hyperglucosuria group, 16 per cent (USPHS) were true positives, 84 per cent false positives (44 per cent RHG, 40 per cent NRHG). In the marked hyperglucosuria group, 72 per cent (USPHS) were true positives, 28 per cent false positives (24 per cent RHG and 4 per cent NRHG). By Clinitest, 23 per cent of the DMs (USPHS) were false negatives, and 1.8 per cent in the normoglucosuria group were false positives. Nine per cent of the DMs were false negatives by RPG > 140, and 4.5 per cent were false negatives by RPG > 120. RUG > 25 mg. per deciliter was as sensitive as the GTT in detecting unknown DMs but was less specific. Random normoglucosuric screenees are unlikely to have diabetes; about 40 per cent of random hyperglucosuric screenees have diabetes. DIABETES 27:810-16, August, 1978.Methods commonly used to determine urine glucose are either insensitive and nonspecific (Clinitest) or sensitive and relatively specific but not quantitative (Clinistix, Keto-diastix, Tes-Tape). 1>2 It has been recommended that diabetes screening be done using more sensitive and specific plasma glucose measurements, preferably after a glucose load. 3 Unfortunately, such methods involve blood collection; thus, they are invasive, expensive, and slow. For this reason, there appears to be an unmet need for a reliable urine screening technique for diabetes, with the method being glucose specific, sensitive, noninvasive, inexpensive, and rapid.Two specific enzymatic methods-glucose oxidase 4 ' 6 and hexokinase 5 -have been developed to measure glucose in blood, plasma, and urine. The original glucose oxidase procedure 4 was colorimetric and measured hydrogen peroxide formation. Si...

Screening for diabetes in schoolchildren in Trinidad, West Indies

“…A sensitivity of 35.3% and a specificity of 99.7% were reported by West and Kalbfleisch. 26 In a prospective diagnostic study collecting urine from fasted subjects, Davidson et al 27 reported a sensitivity of 74% and a specificity of 86% whereas Friderichsen and Maunsbach 28 reported a sensitivity of 20.8%, specificity of 99.14% and a PPV of 46.88%. We are aware that urinalysis is not sufficiently sensitive to detect a high proportion of persons with diabetes and has the potential to find more false negatives than blood screening, but, nevertheless, these mass screening data suggest that, in a developing country such as Trinidad and Tobago, childhood diabetes of all types can be identified by glycosuria.…”