Identification of an Effective Diabetes Screening Strategy: Analysis of the Screening for Impaired Glucose Tolerance Study Open Access
Vakili, Jessica (2012)
Abstract
Background: Establishing an effective and systematic formal
screening test is ideal for managing the
public health burden resulting from diabetes. The oral glucose
tolerance test (OGTT) is the standard to
identify diabetes with maximum sensitivity and specificity.
However, this test is quite time intensive and
inconvenient for patients. We sought to determine if pairing
simpler tests together might be a reasonable
substitute for OGTT.
Methods: The final sample of the Screening for Impaired
Glucose Tolerance study involved 1,573
subjects without known diabetes. Tests collected on these subjects
included random plasma glucose
(RPG), hemoglobin A1c, glucose challenge test (GCT), fasting plasma
glucose (FPG), and an OGTT.
Four different disease statuses were defined to signify a positive
diagnosis for diabetes. For each
definition of diabetes, receiver operating characteristic curve
were produced for individual tests as well as
for combinations of two tests.
Results: Despite disease status, OGTT and FPG consistently
had the two highest areas under the curve
analyzing all subjects. Additionally, the majority of paired tests
were significantly higher than their
matching single tests proving combinations of simple tests improve
screening accuracy. FPG + GCT was
the combined test identified with the highest area under the curve
for standard diabetes and high-risk
prediabetes. Instead of using an OGTT, GCT could be performed
conveniently during an outpatient visit,
followed by an FPG in patients previously screened with GCT.
Discussion: Our data and results do suggest that strong
consideration should be given to screening. These
findings propose that opportunistic screening in a clinical setting
of individuals at high-risk would be
justified and thus will help delay the onset of type 2 diabetes.
Further research of this screening methods'
cost effectiveness would be necessary as well as future research
into additional diabetes screening
methods.
Table of Contents
Table of Contents
Introduction.....................................................1
Screening for
Diabetes.........................................2
Current Screening/Testing Options..........................4
Study
Goals.......................................................7
Methods............................................................8
Protocol and Measurements...................................8
Analysis.............................................................9
Results...........................................................................12
Demographics of
Participants...............................................12
Diabetes Definition as OGTT>199 or
FPG>125..........................12
Diabetes Definition: High-Risk
Prediabetes...............................15
Diabetes Definition as OGTT>199 or A1C ≥
6.5%......................16
Diabetes Definition as OGTT>199 or A1c≥6.5 or
FPG>125...........17
Discussion.......................................................................19
Principal
Findings................................................................19
Review of
A1c....................................................................20
Glucose Challenge
Test........................................................20
Paired Tests in Previous
Literature..........................................21
Limitations.........................................................................22
Future
Research.................................................................22
Conclusions.......................................................................23
References.......................................................................24
Tables..............................................................................26
About this Master's Thesis
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