Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China

Abstract

IntroductionTo compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population.Research design and methodsTwo multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed.ResultsOf numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L.ConclusionsOur results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening.

Assessing the Effectiveness of Type 2 Diabetes Screening in the Republic of Uzbekistan

“…Suggested strategies for screening T2DM include fasting plasma glucose and HbA1c, diabetes risk assessment using the DRS scale and various questionnaires, as well as a combination of the given strategies. A study conducted in Shanghai, China, demonstrated the feasibility of screening for T2DM by assessing fasting plasma glucose levels in the adult population (28). The authors' specific risk assessment system included the data on age, sex, BMI, WC, systolic BP, and family history of T2DM.…”

Prevalence trends and disease burden of diabetes and prediabetes in Chinese adults of Shanghai

“…BP was measured on the right arm in the sitting position using standard mercury sphygmomanometer after at least 5‐min rest 17 . The interval of two BP measurements was at least 2 min and the mean was used in data analysis 15,18,19 . Body mass index (BMI) was calculated as body weight in kilograms divided by standing height in meters squared (kg/m 2 ).…”

“…17 The interval of two BP measurements was at least 2 min and the mean was used in data analysis. 15,18,19 Body mass index (BMI) was calculated as body weight in kilograms divided by standing height in meters squared (kg/m 2 ).…”

“…For each subject without history of diabetes, an oral glucose tolerance test (OGTT) was performed using the standard 75 g-glucose load to measure 2hPG. 15,[18][19][20] HbA1c levels were measured via high-performance liquid chromatography according to the recommendation of the National Glycohemoglobin Standardization Program. 21 Non-anticoagulated venous blood specimen was collected for the measurement of triglyceride (TG), lowdensity lipoprotein cholesterol (LDLC), and high-density lipoprotein cholesterol (HDLC).…”

Dynamic changes in metabolic health status in Chinese adults: Multiple population‐based surveys in Shanghai, China

“…The details of the three surveys using multistage stratified sampling procedure were described in our previous reports 18 , 19 , 20 . Briefly, a representative sample of the general population was randomly selected through a multistage sampling process in the 2002–2003 survey.…”