Comparison of Screening Tests for Non-Insulin-Dependent Diabetes Mellitus

Hanson, Robert L.; Nelson, Robert G.; McCance, David R.; Beart, Jennifer A.; Charles, Marie‐Aline; Pettitt, David J.; Knowler, William C.

doi:10.1001/archinte.1993.00410180083010

Cited by 65 publications

(31 citation statements)

References 31 publications

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“…Although the specificity of such tests is near 100%, the sensitivity may range from 37-75%. 35 Therefore, it is possible that controls used in this Body fat distribution and risk of diabetes AD Rosenthal et al study may actually have subclinical diabetes, thus biasing the risk estimate towards the null. Furthermore, there is the potential for selection bias since not all subjects with glucosuria were tested for diabetes.…”

Section: Discussionmentioning

confidence: 95%

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Body fat distribution and risk of diabetes among Chinese women

et al. 2004

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OBJECTIVE: To assess the relationship between measures of central and overall obesity and risk of diabetes. DESIGN: Nested case-control study. SETTING: Shanghai, China. PARTICIPANTS: A total of 57 130 women were screened for diabetes at enrollment for the Shanghai Women's Health Study (SWHS), a population-based cohort study of Chinese women aged 40-70 y. In this study, 345 women diagnosed with diabetes and 2760 age-matched controls (eight controls per case), randomly selected from women who tested negative for urine glucose, were included. RESULTS: Risk of diabetes increased significantly with increasing levels of obesity, particularly with measures of central obesity. Compared to those in the lowest quartile, women in the highest quartile of body mass index (BMI) (Z26.57) and waist to hip ratio (WHR) (Z0.855) had a 2.57-fold (95% CI 1.75-3.77) and a 6.05-fold (95% CI 4.05-9.04) increased risk of diabetes, respectively. The risk of diabetes was elevated with increasing WHR at all levels of BMI, while the positive association between BMI and diabetes was observed primarily among women with a low WHR. However, test for multiplicative interaction was not statistically significant. CONCLUSIONS: Our data indicated that central obesity is a stronger risk factor for diabetes than overall obesity, suggesting that WHR may be a better indicator of risk of diabetes than BMI among Chinese women. IntroductionEstimates from the World Health Organization predict that by the year 2025, 300 million people worldwide will be diagnosed with diabetes. 1 The Asian/Pacific region, accounting for 46 percent of the global burden of diabetes, includes the largest population of people diagnosed with diabetes in the world. 2 Studies among the Chinese have demonstrated an increase in the prevalence of diabetes during the past 10 years, particularly in urban areas such as Shanghai. [3][4][5][6][7][8][9] The increased prevalence of type II diabetes in these and other Asian populations can be attributed, at least partially, to increases in obesity. 2,[5][6][7]10 Body mass index (BMI) and waist to hip ratio (WHR) are the two anthropometric measurements most frequently used to assess obesity and central obesity. Although epidemiological studies have demonstrated that both BMI and WHR are powerful predictors of type II diabetes, the relative contribution of each to an individual's risk remains unclear. [11][12][13][14][15][16][17][18][19] Further complicating this issue, quantitative definitions used to indicate obesity differ among studies and among gender and ethnic groups. The World Health Organization currently defines overweight as a BMI of 25-29.9 kg/m 2 and obese as a BMI Z30 kg/m 2 . 20 However, compared to Caucasians, Chinese people appear to have a higher body fat percentage given the same BMI. 5 Specifically, 32 percent body fat, which is considered obese by the WHO, corresponded to a BMI of only 21.2 kg/m 2 in Chinese women, which is considered Furthermore, given the strong correlation between central and overall obesity, and the hig...

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Body fat distribution and risk of diabetes among Chinese women

et al. 2004

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“…The gold standard test might be the OGTT (or the modified version with just FPG and 2-hour PG) but repeated a week later, because of its imperfect reproducibility. However, it is impractical and, as Hanson and colleagues 128 pointed out, the emphasis on the OGTT may be part of the reason why so many people in the USA are undiagnosed. A slightly less good test may in practice be more useful by being applied more frequently.…”

Section: Discussionmentioning

confidence: 99%

Screening for type 2 diabetes: literature review and economic modelling

Waugh¹,

Scotland²,

McNamee³

et al. 2007

Health Technol Assess

243

194

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“…The issues with the technical aspects of the assay were highlighted by studies in which samples for the measurement of HbA 1c were split between assays, yielding extreme variability in the results (35,36). Indeed, large epidemiological studies have suggested that HbA 1c testing is less sensitive than FPG measurement in terms of its diagnostic capabilities (37,38). However, data from the present study (obtained in a well-defined at-risk population) and data from previous reports (obtained in more general populations) (39,40) indicate that the combination of FPG and HbA 1c measurements is more predictive than either parameter alone.…”

Section: Conclusion -Previous Reportsmentioning

confidence: 99%

HbA1c Measurement Improves the Detection of Type 2 Diabetes in High-Risk Individuals With Nondiagnostic Levels of Fasting Plasma Glucose

Perry¹,

et al. 2001

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OBJECTIVE -Whereas new diagnostic criteria based on a fasting plasma glucose (FPG) of Ͼ126 mg/dl (7.8 mmol/l) have improved the detection of diabetes, multiple reports indicate that many people with diabetes diagnosed by 2-h oral glucose tolerance test (OGTT) glucose measurements of Ն11.1 mmol/l (200 mg/dl) would remain undiagnosed based on this FPG criteria. Thus, improved methods to detect diabetes are particularly needed for high-risk individuals. We evaluated whether the combination of FPG and HbA 1c measurements enhanced detection of diabetes in those individuals at risk for diabetes with nondiagnostic or minimally elevated FPG. RESEARCH DESIGN AND METHODS -We analyzed FPG, OGTT, and HbA 1c data from 244 subjects screened for participation in the Early Diabetes Intervention Program (EDIP).RESULTS -Of 244 high-risk subjects studied by FPG measurements and OGTT, 24% of the individuals with FPG levels of 5.5-6.0 mmol/l (100 -109 mg/dl) had OGTT-diagnosed diabetes, and nearly 50% of the individuals with FPG levels of 6.1-6.9 mmol/l (110 -125 mg/dl) had OGTT-diagnosed diabetes. In the subjects with OGTT-diagnosed diabetes and FPG levels between 5.5 and 8.0 mmol/l, detection of an elevated HbA 1c (Ͼ6.1% or mean ϩ 2 SDs) led to a substantial improvement in diagnostic sensitivity over the FPG threshold of 7.0 mmol/l (61 vs. 45%, respectively, P ϭ 0.002). Concordant FPG levels Ն7.0 mmol/l (currently recommended for diagnosis) occurred in only 19% of our cohort with type 2 diabetes. CONCLUSIONS -Diagnostic criteria based on FPG criteria are relatively insensitive in the detection of early type 2 diabetes in at-risk subjects. HbA 1c measurement improves the sensitivity of screening in high-risk individuals. Diabetes Care 24:465-471, 2001

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Comparison of Screening Tests for Non-Insulin-Dependent Diabetes Mellitus

Abstract: Although FPG has the best screening properties, HbA1c, HbA1, and quantitative urine glucose also provide high specificity and approximately 80% sensitivity in detecting NIDDM. The choice of a particular method could depend on cost, convenience, and availability.

Cited by 65 publications

References 31 publications

Body fat distribution and risk of diabetes among Chinese women

Body fat distribution and risk of diabetes among Chinese women

Screening for type 2 diabetes: literature review and economic modelling

HbA1c Measurement Improves the Detection of Type 2 Diabetes in High-Risk Individuals With Nondiagnostic Levels of Fasting Plasma Glucose

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