Opportunistic Screening for Diabetes in Routine Clinical Practice

Ealovega, Mark W.; Tabaei, Bahman P.; Brändle, Michael; Burke, Ray; Herman, William H.

doi:10.2337/diacare.27.1.9

Cited by 136 publications

(127 citation statements)

References 15 publications

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“…Finally, nearly all studies that have estimated screening prevalence have been in single centers or health management organizations, and have shown varying rates. [8][9][10] There are known racial disparities in the burden of diabetes; non-white Americans have a higher prevalence of disease, 11 worse glycemic control, 12 higher rates of complications, 13 and higher mortality. 14 Nearly 3 % of US adults have undiagnosed diabetes; rates are higher among non-Hispanic blacks and Mexican Americans.…”

Section: Introductionmentioning

confidence: 99%

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

et al. 2014

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BACKGROUND: There are few current population-based estimates of the patterns of diabetes screening in the United States. The American Diabetes Association (ADA) recommends universal screening of adults ≥ 45 years, and high-risk adults < 45 years, but there is no current assessment of ADA guideline performance in detecting diabetes and prediabetes. Furthermore, data on racial/ ethnic patterns of screening are limited. OBJECTIVE: Our aim was to estimate diabetes screening prevalence for the US adult population and specifically for those who meet ADA criteria; to report the prevalence of prediabetes and diabetes among these groups; and to determine if high-risk race/ethnicity was associated with reported screening. DESIGN: This was a Cross-sectional survey. PARTICIPANTS: Non-pregnant adults (≥ 21 years) without diabetes or prediabetes who participated in the National Health and Nutrition Examination Survey (NHANES) in 2005-2012 (n=17,572) were included in the study. "Screening-recommended" participants, classified by ADA criteria, included (1) adults ≥ 45 years and (2) "high-risk" adults < 45 years. "Screening-not-recommended" participants were adults < 45 years who did not meet criteria. MAIN MEASURES: Diabetes screening status was obtained by self-report. We used calibrated HbA 1c and/or fasting glucose levels to define undiagnosed diabetes and prediabetes. KEY RESULTS: Seventy-six percent of the study population (approximately 136 million US adults) met ADA criteria. Among them, less than half (46.2 %) reported screening; undiagnosed diabetes affected 3.7 % (5 million individuals), and undiagnosed prediabetes affected 36.3 % (49 million people.) African Americans were more likely to report screening, both among adults ≥ 45 years and among "high risk" younger adults (OR 1.27 and 1.36, respectively.) Hispanic participants were also more likely to report screening (OR 1.31 for older adults, 1.42 for younger adults.) The screening rate among "screeningnot-recommended" adults was 29.6 %; the prevalence of diabetes and prediabetes were 0.4 and 10.2 %, respectively. CONCLUSIONS:In a nationally representative sample, 76 % of adults met ADA screening criteria, of whom fewer than half reported screening. Limitations include crosssectional design and screening self-report.

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Section: Introductionmentioning

confidence: 99%

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

et al. 2014

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“…In contrast, detection earlier in the natural history at the stage of prediabetes can enable lifestyle change and/or use of pharmacological agents to keep glucose levels near-normal, prevent or delay the development of diabetes, and improve other CVD risk factors [9,10]. However, the 20% of Americans with prediabetes [11] and 6 million Americans with diabetes [12] are undiagnosed because most Americans are not screened in any systematic way [13].…”

Section: Introductionmentioning

confidence: 99%

Glucose challenge test screening for prediabetes and undiagnosed diabetes

et al. 2009

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Aims/hypothesis Diabetes prevention and care are limited by lack of screening. We hypothesised that screening could be done with a strategy similar to that used near-universally for gestational diabetes, i.e. a 50 g oral glucose challenge test (GCT) performed at any time of day, regardless of meal status, with one 1 h sample. Methods At a first visit, participants had random plasma and capillary glucose measured, followed by the GCT with plasma and capillary glucose (GCTplasma and GCTcap, respectively). At a second visit, participants had HbA 1c measured and a diagnostic 75 g OGTT. ResultsThe 1,573 participants had mean age of 48 years, BMI 30.3 kg/m 2 and 58% were women and 58% were black. Diabetes (defined by WHO) was present in 4.6% and prediabetes (defined as impaired glucose tolerance [2 h glucose 7.8-11.1 (140-199 mg/dl) with fasting glucose ≤6.9 (125 mg/dl)] and/or impaired fasting glucose with plasma glucose 6.1-6.9 mmol/l [110-125 mg/dl]) in 18.7%. The GCTplasma provided areas under the receiver-operatingcharacteristic curves of 0.90, 0.82 and 0.79 for detection of diabetes, diabetes or prediabetes, and prediabetes, respectively, all of which were higher than GCTcap, random and capillary glucose, and HbA 1c (p<0.02 for all). The perfor- mance of GCTplasma was unaffected by time after meals or time of day, and was better in blacks than whites, but otherwise comparable in men and women, and in groups with differing prevalence of glucose intolerance. GCTplasma screening would cost approximately US$84 to identify one person with previously unrecognised diabetes or prediabetes. Conclusions/interpretation GCT screening for prediabetes and previously unrecognised diabetes would be accurate, convenient and inexpensive. Widespread use of GCT screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications.

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“…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.…”

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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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Opportunistic Screening for Diabetes in Routine Clinical Practice

Cited by 136 publications

References 15 publications

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

Glucose challenge test screening for prediabetes and undiagnosed diabetes

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

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