Community-Based Screening for Diabetes in Michigan

Tabaei, Bahman P.; Burke, Ray; Constance, Ann; Hare, J.; May-Aldrich, Glenda; Parker, Sandra A.; Scott, Ann; Stys, Anne; Chickering, Jean; Herman, William H.

doi:10.2337/diacare.26.3.668

Cited by 45 publications

(33 citation statements)

References 8 publications

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“…4 Prior reports of diabetes screening in community and clinical venues have yielded mixed results, often limited by low prevalence rates and poor follow-up. [36][37][38] Similar to any disease screening, patient adherence with confirmatory testing and subsequent therapy is vital to the successful implementation. Additionally, the cost-effectiveness of opportunistic diabetes screening is unclear and will require further investigation.…”

Section: Discussionmentioning

confidence: 99%

Value of Risk Stratification to Increase the Predictive Validity of HbA1c in Screening for Undiagnosed Diabetes in the US Population

et al. 2008

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BACKGROUND: Opportunistic screening using hemoglobin A1c (HbA1c) may improve detection of undiagnosed diabetes but remains controversial. OBJECTIVE:To evaluate the predictive validity of HbA1c as a screening test for undiagnosed diabetes in a risk-stratified sample of the US population. DESIGN:Weighted cross-sectional analysis of diabetes risk factors, HbA1c, and fasting plasma glucose (FPG) in National Health and Nutrition Examination Survey (NHANES), 1999-2004. SUBJECTS:Six thousand seven hundred and twentythree NHANES participants from morning examination session, aged ≥18 years and without prior physiciandiagnosed diabetes.MEASUREMENTS: HbA1c and undiagnosed diabetes defined by FPG ≥ 7.0 mmol/l (126 mg/dl). RESULTS:The estimated prevalence of undiagnosed diabetes in the US population was 2.8% (5.5 million people). HbA1c had strong correlation with undiagnosed diabetes, with an area under the receiver-operating characteristic curve of 0.93. Independent predictors of undiagnosed diabetes were older age, male sex, black race, hypertension, elevated waist circumference, elevated triglycerides, and low high-density lipoprotein cholesterol. We derived a risk score for undiagnosed diabetes and stratified participants into low (0.44% prevalence), moderate (4.1% prevalence), and high (11.1% prevalence) risk subgroups. In moderate and high risk groups, a threshold HbA1c value ≥ 6.1% identified patients requiring confirmatory FPG; HbA1c ≤ 5.4% identified patients for whom diabetes could be reliably excluded. Intermediate HbA1c (5.5-6.0%) may exclude diabetes in moderate, but not high risk groups).CONCLUSIONS: Risk stratification improves the predictive validity of HbA1c in screening for undiagnosed diabetes in the US population. Although opportunistic screening with HbA1c would improve detection of undiagnosed diabetes, cost-effectiveness studies are needed before implementation of specific screening strategies using HbA1c.

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Section: Discussionmentioning

confidence: 99%

Value of Risk Stratification to Increase the Predictive Validity of HbA1c in Screening for Undiagnosed Diabetes in the US Population

et al. 2008

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“…Although the absolute costs associated with population screening are less, fewer people require population screening than opportunistic screening (18.2 million vs. 54.4 million). Studies of community screening have suggested that the yield of screening may be higher among those without regular health care (13). However, even if the yield is twofold higher in population-based screening, it remains less efficient.…”

Section: Cost Analysismentioning

confidence: 99%

The Efficacy and Cost of Alternative Strategies for Systematic Screening for Type 2 Diabetes in the U.S. Population 45–74 Years of Age

2005

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OBJECTIVE -To simulate the outcomes of alternative strategies for screening the U.S. population 45-74 years of age for type 2 diabetes. RESEARCH DESIGN AND METHODS-We simulated screening with random plasma glucose (RPG) and cut points of 100, 130, and 160 mg/dl and a multivariate equation including RPG and other variables. Over 15 years, we simulated screening at intervals of 1, 3, and 5 years. All positive screening tests were followed by a diagnostic fasting plasma glucose or an oral glucose tolerance test. Outcomes include the numbers of false-negative, true-positive, and false-positive screening tests and the direct and indirect costs.RESULTS -At year 15, screening every 3 years with an RPG cut point of 100 mg/dl left 0.2 million false negatives, an RPG of 130 mg/dl or the equation left 1.3 million false negatives, and an RPG of 160 mg/dl left 2.8 million false negatives. Over 15 years, the absolute difference between the most sensitive and most specific screening strategy was 4.5 million true positives and 476 million false-positives. Strategies using RPG cut points of 130 mg/dl or the multivariate equation every 3 years identified 17.3 million true positives; however, the equation identified fewer false-positives. The total cost of the most sensitive screening strategy was $42.7 billion and that of the most specific strategy was $6.9 billion.CONCLUSIONS -Screening for type 2 diabetes every 3 years with an RPG cut point of 130 mg/dl or the multivariate equation provides good yield and minimizes false-positive screening tests and costs. Diabetes Care 28:307-311, 2005I n the United States, the costs of diabetes are staggering. In 2002, the direct and indirect costs of diabetes were estimated to be $132 billion (1). The enormous cost of diabetes and the ease of detecting type 2 diabetes in its preclinical stage led the American Diabetes Association (ADA) to recommend screening asymptomatic persons Ն45 years of age for diabetes (2). Although the ADA currently recommends screening with a fasting plasma glucose (FPG), it had recommended screening with a random plasma glucose (RPG) as recently as 2000 (3). Indeed, RPG remains clinicians' preferred method of screening. Among nondiabetic individuals Ն45 years of age enrolled in a large managed care organization, 95% of glucose testing involved RPG (4). Despite the frequent occurrence of RPG screening, substantial controversy remains as to the optimal cut point to define an abnormal test (5) and the optimal frequency of screening. To address these questions, we modeled several systematic approaches to screening the U.S. population 45-74 years of age for diabetes. We assessed screening with RPG cut points of 100, 130, and 160 mg/dl and screening using RPG and other risk factors in a multivariate equation (6). We assessed screening at 1-, 3-, and 5-year intervals over 15 years. We assumed that all positive screening tests were followed by a definitive diagnostic test: an FPG for those with RPG Ն200 mg/dl and a 2-h 75-g oral glucose tolerance test (OGTT) for those with ...

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“…Community screening outside a health care setting is not recommended because people with positive tests may not seek, or have access to, appropriate follow-up testing and care. Community testing may also be poorly targeted; i.e., it may fail to reach the groups most at risk and inappropriately test those at very low risk or even those who have already been diagnosed (38).…”

Section: Community Screeningmentioning

confidence: 99%