Screening for type 2 diabetes: a short report for the National Screening Committee

Waugh, Norman; Shyangdan, D; Taylor‐Phillips, Sian; Suri, Gaurav; Hall, Barry

doi:10.3310/hta17350

Cited by 95 publications

(74 citation statements)

References 134 publications

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“…1 Although type 2 diabetes mellitus is induced by various environmental and genetic factors, its detailed aetiology is not yet fully understood. 2 Several studies have reported that multiple cytokines may be involved in the regulation of the immune response, which has in turn been shown to play a role in the pathogenesis of type 2 diabetes mellitus. 3,4 Interleukins are a diverse constellation of small cell signalling protein molecules, or cytokines, that regulate the function of the immune system in humans.…”

Section: Introductionmentioning

confidence: 99%

Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population

Bai¹,

Jing²,

Guo³

et al. 2014

J Int Med Res

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Objective: To investigate the relationship between the interleukin 10 (IL10) gene single nucleotide polymorphisms (SNP) À1082 G/A (rs1800896), À819 T/C (rs1800871) and À592 A/C (rs1800872) and risk of type 2 diabetes mellitus in a Chinese population. Methods: This case-control study recruited patients with type 2 diabetes mellitus and healthy control subjects. Genotyping of the À1082 G/A (rs1800896), À819 T/C (rs1800871) and À592 A/C (rs1800872) SNPs was conducted and genotype frequencies were compared between the two groups. Results: The study recruited 364 patients with type 2 diabetes mellitus and 677 healthy controls. Patients carrying the À1082 GG genotype had a significantly increased risk of type 2 diabetes mellitus (adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03, 2.68), as did those patients carrying the À592 AA genotype (adjusted OR 1.63, 95% CI 1.06, 2.53). Subjects carrying both the À1082 GA þ GG and À592 AC þ AA genotypes had a significantly increased risk of type 2 diabetes mellitus (adjusted OR 2.03, 95% CI 1.24, 3.15). Conclusions: The SNPs À1082G/A and À592 A/C increased the risk for type 2 diabetes mellitus, and could be potential targets for screening for the early detection of the risk of type 2 diabetes mellitus.

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Section: Introductionmentioning

confidence: 99%

Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population

Bai¹,

Jing²,

Guo³

et al. 2014

J Int Med Res

View full text Add to dashboard Cite

show abstract

“…19 While national and international diabetes associations call for screening of most adults over the age of 40-50 years and screening of all adults with risk factors, [20][21][22] other agencies recommend testing only in the setting of hypertension, 23,24 hyperlipidemia, 23 or as part of risk evaluation in patients with CVD. 25,26 Screening might be more common in large healthcare systems if adverse associations with diabetes, such as increased healthcare costs, were widely recognized to occur early in the natural history of the disease, at a time when adverse effects might be forestalled with preventive management. Higher rates of CVD, increased healthcare resource use, and higher costs have been reported before a clinical diagnosis of diabetes in data from the Nurses' Health Study, primary care clinics in the United Kingdom, and Kaiser Permanente Northwest (KPNW), respectively, [27][28][29][30][31] but there has been no coordinated study of the time course of adverse associations with early diabetes within a single healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Increased Cardiovascular Disease, Resource Use, and Costs Before the Clinical Diagnosis of Diabetes in Veterans in the Southeastern U.S.

et al. 2015

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IMPORTANCE:Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. OBJECTIVE: The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. DESIGN: Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. SETTING: VA facilities in SC, GA, and AL. PARTICIPANTS: Patients with and without diagnosed diabetes. MAIN OUTCOME MEASURES: Diagnosed CVD, resource use, and costs. RESULTS: In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year −4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year −2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year −4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs KEY WORDS: diabetes; health care cost; cardiovascular disease; prediabetes. ABBREVIATIONS A1cHemoglobin A1c 749(p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). CONCLUSIONS AND RELEVANCE: VA costs per veteran are higher-over $1,000/year before and $2,000/year after diagnosis of diabetes-due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.

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“…Traditionally, diabetes or prediabetes have been defined by glucose measurements based on a substantial body of evidence. 1,16 However, there is also consid- …”

Section: Discussionmentioning

confidence: 99%

“…There are unresolved issues around the identification of those at future risk of diabetes, but one option recommended by the National Institute for Health and Care Excellence (NICE) is to use glycated haemoglobin (HbA1c). 1 This approach is controversial, but it would avoid the issue of poor repeatability and inconvenience of the oral glucose tolerance test which has dogged the area for many years. There is a growing body of evidence around the use of HbA1c in diagnosis and screening for diabetes.…”

Section: Introductionmentioning

confidence: 99%

The use of glucose measurements to improve screening for diabetes in clinical practice

et al. 2016

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Introduction: It is estimated that 4 million people will be living with diabetes in England by 2025. It is imperative that we can accurately identify people at risk of diabetes and target interventions to prevent its development. Aim: To determine whether the addition of glucose measurements to the Leicester Risk Assessment Score (LRAS) improves the prediction of HbA1c ≥42mmol/mol (6.0%) compared with a risk score alone, and reduces the number requiring additional tests to determine their glycaemic status. Method: LRAS and HbA 1c were assessed in 484 participants (aged 40-80 years). 184 participants recruited directly from primary care underwent a fasting glucose measurement while 300 participants recruited through advertisement to the general public attended for a random capillary glucose. Results: A LRAS of ≥17 had a sensitivity of 79.6% and specificity of 60.1% to predict the HbA1c value of ≥42 mmol/mol (6.0%). The addition of a fasting glucose to the LRAS improved the explained variation in HbA1c from 20.8% with a risk score alone to 46.7%. In addition the number of people requiring further assessment of their glucose status was reduced from 43.8% to 33.2%. The addition of a random capillary glucose to the LRAS did not significantly improve the model. Conclusions: The addition of a fasting blood glucose, but not a random capillary glucose, to the LRAS improves the prediction of HbA1c ≥42mmol/mol (6.0%) and reduced the number of people who would need further diagnostic testing for diabetes.

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Screening for type 2 diabetes: a short report for the National Screening Committee

Cited by 95 publications

References 134 publications

Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population

Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population

Increased Cardiovascular Disease, Resource Use, and Costs Before the Clinical Diagnosis of Diabetes in Veterans in the Southeastern U.S.

The use of glucose measurements to improve screening for diabetes in clinical practice

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