Identification of an Effective Diabetes Screening Strategy: Analysis of the Screening for Impaired Glucose Tolerance Study Public

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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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	SIGT OGTT ROC analysis Type 2 Diabetes Screening Diabetes Screening Strategy
Committee Chair / Thesis Advisor	Long, Qi, Emory University
Committee Members	Phillips, Lawrence S, Emory University Olson, Darin Erik, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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