Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Rolka, Deborah B.; Narayan, K.M. Venkat; Thompson, Theodore; Goldman, Dona; Lindenmayer, Joann M.; Alich, Kate; Bacall, Darcy; Benjamin, Evan M.; Lamb, Betty; Stuart, Dennis O.; Engelgau, Michael M.

doi:10.2337/diacare.24.11.1899

Cited by 121 publications

(114 citation statements)

References 17 publications

(11 reference statements)

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“…Our selection of strategies to detect pre-diabetes was based on information available on screening tests and the feasibility of large-scale screening in clinicians' offices. We examined five screening strategies: 1) testing all with an oral glucose tolerance test (OGTT), in which all individuals in the study popu-lation receive a 2-h OGTT; 2) fasting plasma glucose (FPG) testing, in which all people receive a FPG test and those who test positive but do not have IFG or undiagnosed diabetes would then be given an OGTT; 3) HbA 1c screening, in which all individuals receive an HbA 1c test and those who test positive would then be given an OGTT; 4) capillary blood glucose (CBG) screening, in which all individuals receive a CBG test and those who test positive would then be given an OGTT; and 5) a risk assessment questionnaire screening, in which all people respond to a risk assessment questionnaire for type 2 diabetes and those who score a total Ն10 points would then be given an OGTT (10).…”

Section: Analytical Proceduresmentioning

confidence: 99%

Costs of Screening for Pre-diabetes Among U.S. Adults

et al. 2003

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OBJECTIVE -We evaluated various strategies to identify individuals aged 45-74 years with pre-diabetes (either impaired glucose tolerance or impaired fasting glucose). RESEARCH DESIGN AND METHODS -We conducted a cost analysis to evaluate the effectiveness (proportion of cases identified), total costs, and efficiency (cost per case identified) of five detection strategies: an oral glucose tolerance test (OGTT), a fasting plasma glucose (FPG) test, an HbA 1c test, a capillary blood glucose (CBG) test, and a risk assessment questionnaire. For the first strategy, all individuals received an OGTT. For the last four strategies, only those with a positive screening test received an OGTT. Data were from the Third U.S. National Health and Nutrition Examination Survey, 2000 census, Medicare, and published literature. One-time screening costs were estimated from both a single-payer perspective and a societal perspective.RESULTS -The proportion of pre-diabetes and undiagnosed diabetes identified ranged from 69% to 100% (12.1-17.5 million). The cost per case identified ranged from $176 to $236 from a single-payer perspective and from $247 to $332 from a societal perspective. Testing all with OGTT was the most effective strategy, but the CBG test and risk assessment questionnaire were the most efficient. If people are substantially less willing to take an OGTT than a FPG test, then the FPG testing strategy was the most effective strategy.CONCLUSIONS -There is a tradeoff between effectiveness and efficiency in choosing a strategy. The most favorable strategy depends on if the goal of the screening program is to identify more cases or to pursue the lowest cost per case. The expected percentage of the population willing to take an OGTT is also a consideration. Diabetes Care 26:2536 -2542, 2003T ype 2 diabetes is a serious and costly disease and a growing public health problem (1,2). Despite the availability and use of a number of effective treatments to prevent diabetes complications, the disease pursues a degenerative path. Results of recent clinical trials indicate that the progression to diabetes from impaired glucose tolerance (IGT) can be delayed or prevented substantially by lifestyle modification or medications (3-5).Responding to the results of the Diabetes Prevention Program (DPP) and other prevention trials, the American Diabetes Association (ADA) has recommended that diabetes prevention efforts target people with pre-diabetes (either IGT or impaired fasting glucose [IFG]) (6). To identify people with pre-diabetes, the ADA has recommended screening during a health care office visit for men and women who are age Ն45 years, particularly those with a BMI Ն25 kg/m 2 . The purpose of this study was to examine the effectiveness, costs, and efficiency of five strategies to identify people with prediabetes based on a one-time screening of the U.S population. RESEARCH DESIGN AND METHODS Study populationOur study population included individuals age 45-74 years who visited a health care provider at least once in the past year and ...

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Section: Analytical Proceduresmentioning

confidence: 99%

Costs of Screening for Pre-diabetes Among U.S. Adults

et al. 2003

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“…One of the objectives of this plan is to develop simple strategies to identify those at risk and provide them with early lifestyle interventions. As the glucose test is invasive, relatively expensive, time consuming and not easy to apply to massscreening programmes, several other diagnostic tools, including obesity indicators such as waist circumference (WC) and body mass index (BMI), have been proposed and applied in diabetes prevention programmes in recent years (Rolka et al, 2001;Lindstrom and Tuomilehto, 2003;Schulze et al, 2007). However, controversial opinions exist on which of the obesity measures, WC (waist-to-hip ratio (WHR)) or BMI, is more strongly associated with the increased risk of type II diabetes.…”

Section: Introductionmentioning

confidence: 99%

Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?

2009

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In total, 17 prospective and 35 cross-sectional studies in adults aged 18-74 years, with the aim of comparing betweenbody mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) in their relation to the incidence and prevalence of type II diabetes, were reviewed. Among these studies, only a few have used C-statistic, paired homogeneity test or log-likelihood ratio test for formally comparing the differences. Five prospective studies, in which formal statistic tests have been made, came out with inconsistent findings: two results were in favour of WC in Mexicans African Americanss, respectively, one result was in favour of BMI in Pima Indians, and no difference was found in the other 2 studies. Among the 11 cross-sectional studies that have formally tested the differences, most found a higher odds ratio or slightly larger area under the ROC curve (AUC) for WC than for BMI. A meta-analysis based on the individual data of the Asian cohorts using a paired homogeneity test showed, however, that there was no difference in odds ratio between BMI and WC in Chinese, Japanese, Indian, Mongolian and Filipino men. In conclusion, all studies included in this review showed that either BMI or WC (WHR) predicted or was associated with type II diabetes independently, regardless of the controversial findings on which of these obesity indicators is better.

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“…Hypertension was defined as a systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater (based on the mean of the 2 readings) or current therapy with antihypertensive medication. Diabetes was defined as a nonfasting blood glucose concentration of 140 mg/dL (7.8 mmol/L) or greater or a history of diabetes; this definition, based on old criteria, 18 diverges from the recent standard criterion of a fasting blood glucose concentration of more than 126 mg/dL (7.0 mmol/L).…”

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confidence: 99%

Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population

Jafar¹,

Chaturvedi²,

Pappas³

2006

Canadian Medical Association Journal

239

202

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Research D eveloping countries are increasingly vulnerable to the worldwide epidemic of obesity, which affects all segments of the population, including men, women and now children.1,2 Compared with populations in industrialized countries, those in the developing world appear to be at greater risk of the diseases associated with overweight, and cardiovascular disease has become the leading cause of disability and death in many developing countries. 3-5Worldwide, Indo-Asian people are among the populations at highest risk for cardiovascular disease.6 Evidence also suggests that associations between body mass index (BMI), percentage of body fat and chronic disease may differ between Indo-Asian and European populations.7,8 One proposed explanation for these observations is the effect of poverty and resultant malnutrition during intrauterine and early childhood years, coupled with relative overnutrition in later years.9 There may, however, be other factors at work. Because of the observed differences between populations, the International Association for the Study of Obesity and the International Obesity Task Force have suggested lower BMI cutoff values for the definitions of overweight (23.0-24.9 kg/m 2 ) and obesity (25.0 kg/m 2 or greater) in Asian populations.10,11 Estimates of the prevalence of overweight in IndoAsian countries (India, Pakistan, Bangladesh and Sri Lanka) based on these cutoff values have not been reported. Further, it is not known whether the revised definition of overweight would be valid at a population level in terms of being better associated with the consequences of obesity.We therefore sought to determine the prevalence of overweight and obesity using the Asian-specific BMI definition in a Pakistani population. We also studied factors and conditions (hypertension, diabetes mellitus and raised serum cholesterol concentration) associated with being overweight or obese in the Pakistani population, as well as the sensitivity and specificity of various BMI cutoff values for their association with hypertension and diabetes mellitus.

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Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Cited by 121 publications

References 17 publications

Costs of Screening for Pre-diabetes Among U.S. Adults

Costs of Screening for Pre-diabetes Among U.S. Adults

Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?

Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population

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