Performance of an NIDDM Screening Questionnaire Based on Symptoms and Risk Factors

Ruige, Johannes; Neeling, J.N.D. de; Kostense, Piet J.; Bouter, Lex M.; Heine, Robert J.

doi:10.2337/diacare.20.4.491

Cited by 128 publications

(97 citation statements)

References 17 publications

(27 reference statements)

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“…Sensitivity for this WHO criterion was 79%, and specificity was 65% in the initial evaluation of the ADA questionnaire (12). In an evaluation that was conducted using the Netherlands' Hoorn Study population, sensitivity was 72% and specificity was 56% (14).…”

Section: Figure 1-empirical Receiver Operating Characteristic Curvesmentioning

confidence: 96%

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

et al. 2001

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OBJECTIVE -To evaluate the performance, in settings typical of opportunistic and community screening programs, of screening tests currently recommended by the American Diabetes Association (ADA) for detecting undiagnosed diabetes.RESEARCH DESIGN AND METHODS -Volunteers aged Ն20 years without previously diagnosed diabetes (n ϭ 1,471) completed a brief questionnaire and underwent recording of postprandial time and measurement of capillary blood glucose (CBG) with a portable sensor. Participants subsequently underwent a 75-g oral glucose tolerance test; fasting serum glucose (FSG) and 2-h postload serum glucose (2-h SG) concentrations were measured. The screening tests we studied included the ADA risk assessment questionnaire, the recommended CBG cut point of 140 mg/dl, and an alternative CBG cut point of 120 mg/dl. Each screening test was evaluated against several diagnostic criteria for diabetes (FSG Ն126 mg/dl, 2-h SG Ն200 mg/dl, or either) and dysglycemia (FSG Ն110 mg/dl, 2-h SG Ն140 mg/dl, or either).RESULTS -Among all participants, 10.7% had undiagnosed diabetes (FSG Ն126 or 2-h SG Ն200 mg/dl), 52.1% had a positive result on the questionnaire, 9.5% had CBG Ն140 mg/dl, and 18.4% had CBG Ն120 mg/dl. The questionnaire was 72-78% sensitive and 50 -51% specific for the three diabetes diagnostic criteria; CBG Ն140 mg/dl was 56 -65% sensitive and 95-96% specific, and CBG Ն120 mg/dl was 75-84% sensitive and 86 -90% specific. CBG Ն120 mg/dl was 44 -62% sensitive and 89 -90% specific for dysglycemia. CONCLUSIONS -Low specificity may limit the usefulness of the ADA questionnaire. Lowering the cut point for a casual CBG test (e.g., to 120 mg/dl) may improve sensitivity and still provide adequate specificity.

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Section: Figure 1-empirical Receiver Operating Characteristic Curvesmentioning

confidence: 96%

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

et al. 2001

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“…Several risk assessment tools have been developed for this purpose using a combination of demographic, clinical, and sometimes biochemical information (12)(13)(14)(15)(16)(17)32). These risk assessment tools have invariably been developed and tested in Caucasian populations.…”

Section: Glü Mer and Associatesmentioning

confidence: 99%

“…Because of the rapidly increasing prevalence of type 2 diabetes (5)(6)(7)(8), screening individuals at high risk of having undiagnosed diabetes is recommended in several countries (9 -11). Several questionnaires have been developed to detect this high-risk group (12)(13)(14)(15)(16)(17). They all perform equally well, with a sensitivity of 70 -75% and a specificity of 55-70%.…”

mentioning

confidence: 99%

Risk Scores for Type 2 Diabetes Can Be Applied in Some Populations but Not All

Vistisen²,

et al. 2006

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OBJECTIVE -Risk scores based on phenotypic characteristics to identify individuals at high risk of having undiagnosed diabetes have been developed in Caucasian populations. The impact of known risk factors on having undiagnosed type 2 diabetes differs between populations from different ethnic origin, and risk scores developed in Caucasians may not be applicable to other ethnic groups. This study evaluated the performance of one risk score in nine populations of diverse ethnic origin.RESEARCH DESIGN AND METHODS -Data provided by centers from around the world to the DETECT-2 project were used. The database includes population-based surveys with information on at least 500 people without known diabetes having a 75-g oral glucose tolerance test. To date, 52 centers have contributed data on 190,000 individuals from 34 countries. In this analysis, nine cross-sectional studies were selected representing diverse ethnic and regional backgrounds. The risk score assessed uses information on age, sex, blood pressure treatment, and BMI.RESULTS -This analysis included 29,758 individuals; 1,805 individuals had undiagnosed diabetes. The performance of the risk score varied widely, with sensitivity, specificity, and percentage needing further testing ranging between 12 and 57%, 72 and 93%, and 2 and 25%, respectively, with the worse performance in non-Caucasian populations. This variation in performance was related to differences in the association between prevalence of undiagnosed diabetes and components of the risk score.CONCLUSIONS -A typical risk score developed in Caucasian populations cannot be applied to other populations of diverse ethnic origins. Diabetes Care 29:410 -414, 2006T ype 2 diabetes is a common and serious condition associated with reduced life expectancy and considerable morbidity. Recent estimates suggest that currently 195 million people throughout the world have diabetes, and this will increase to over 330 million by 2025 (1). Approximately 50% of people with diabetes are undiagnosed (2,3). Because type 2 diabetes may remain undetected for several years, at the time of clinical diagnosis, many people have one or more micro-or macrovascular complications (4).Detecting people with undiagnosed type 2 diabetes is important for both public health policy and everyday clinical practice. Because of the rapidly increasing prevalence of type 2 diabetes (5-8), screening individuals at high risk of having undiagnosed diabetes is recommended in several countries (9 -11). Several questionnaires have been developed to detect this high-risk group (12-17). They all perform equally well, with a sensitivity of 70 -75% and a specificity of 55-70%. Because the majority of risk scores have been developed and validated in Caucasians (12,18), their applicability to populations of different ethnic background and with different risk factor distribution is uncertain.The DETECT-2 project is an international data pooling collaboration specifically addressing issues related to screening for type 2 diabetes, with an emphasis on the imp...

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“…This is possible only with tools or programmes that ensure systematic tracing of high-risk individuals. Several tools designed to identify highrisk individuals have already been developed [5,6,7,8,9,10,11,12]. These tools were not only developed but also tested in datasets from population-based surveys.…”

Section: Introductionmentioning

confidence: 99%

Population-based stepwise screening for unrecognised Type�2 diabetes is ineffective in general practice despite reliable algorithms

Christensen

Sandbæk²,

Lauritzen

et al. 2004

Diabetologia

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Aims/hypothesis. The yield of screening programmes for Type 2 diabetes in the existing healthcare setting might be lower than anticipated from tests of screening algorithms in data from epidemiological surveys. Our aims were to evaluate the reliability of the algorithms and the effectiveness of a proposed stepwise screening programme for Type 2 diabetes in general practice. Methods. The screening programme had four steps: (i) mail-distributed self-administered risk-chart; (ii) screening tests: random blood glucose (RBG) and HbA 1 c; (iii) diagnostic procedure 1 for fasting blood glucose (FBG) (if RBG ≥5.5 mmol/l or HbA 1 c ≥6.1%); and (iv) OGTT as diagnostic procedure 2 (if 5.6≤FBG<6.1 mmol/l or HbA 1 c ≥6.1%). Abnormalities of glucose metabolism were classified according to the WHO 1999 criteria, based on capillary whole blood. The subjects were all patients between 40 and 69 years of age (n=60,926) who were registered in 88 general practices and had not been previously diagnosed with diabetes.Results. A total of 11,263 individuals had a high-risk risk-score and attended the screening consultation (step 1 test-positive). Of these, 30.1% needed diagnostic tests (step 2 test-positive) and 27.2% of these needed an OGTT (step 3 test-positive). The test-positive proportions were equal to the proportions obtained in data from a population-based survey from Step 2 onwards, and the algorithms were thus reliable. The identification rate was only 19% of all prevalent undiagnosed diabetes according to a recently published prevalence estimate. This was due to a large dropout rate among high-risk individuals prior to entry into the programme. Conclusions/interpretation. Population-based maildistributed stepwise screening for Type 2 diabetes in general practice is ineffective, despite reliable screening algorithms, primarily because many high-risk individuals fail to participate.

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Performance of an NIDDM Screening Questionnaire Based on Symptoms and Risk Factors

Abstract: The newly developed symptom-risk questionnaire has good performance characteristics, and the advantage of a variable cutoff makes it a useful screening tool for NIDDM in general practice.

Cited by 128 publications

References 17 publications

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Risk Scores for Type 2 Diabetes Can Be Applied in Some Populations but Not All

Population-based stepwise screening for unrecognised Type�2 diabetes is ineffective in general practice despite reliable algorithms

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