TY - JOUR
T1 - Performance of a Random Glucose Case-Finding Strategy to Detect Undiagnosed Diabetes
AU - Bowen, Michael E.
AU - Xuan, Lei
AU - Lingvay, Ildiko
AU - Halm, Ethan A.
N1 - Publisher Copyright:
© 2017 American Journal of Preventive Medicine
PY - 2017/6
Y1 - 2017/6
N2 - Introduction Random glucose <200 mg/dL is associated with undiagnosed diabetes but not included in screening guidelines. This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Methods In 2015, cross-sectional data from non-fasting adults without diagnosed diabetes or prediabetes (N=7,161) in the 2007–2012 National Health and Nutrition Examination Surveys were analyzed. Random glucose and survey data were used to assemble the random glucose, American Diabetes Association (ADA), and U.S. Preventive Services Task Force (USPSTF) screening strategies and predict diabetes using hemoglobin A1c criteria. Results Using random glucose ≥100 mg/dL to select individuals for diabetes testing was 81.6% (95% CI=74.9%, 88.4%) sensitive, 78% (95% CI=76.6%, 79.5%) specific and had an area under the receiver operating curve (AROC) of 0.80 (95% CI=0.78, 0.83) to detect undiagnosed diabetes. Overall performance of ADA (AROC=0.59, 95% CI=0.58, 0.60), 2008 USPSTF (AROC=0.62, 95% CI=0.59, 0.65), and 2015 USPSTF (AROC=0.64, 95% CI=0.61, 0.67) guidelines was similar. The random glucose strategy correctly identified one case of undiagnosed diabetes for every 14 people screened, which was more efficient than ADA (number needed to screen, 35), 2008 USPSTF (44), and 2015 USPSTF (32) guidelines. Conclusions Using random glucose ≥100 mg/dL to identify individuals in need of diabetes screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection. Further evaluation of this strategy's effectiveness in real-world clinical practice is needed.
AB - Introduction Random glucose <200 mg/dL is associated with undiagnosed diabetes but not included in screening guidelines. This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Methods In 2015, cross-sectional data from non-fasting adults without diagnosed diabetes or prediabetes (N=7,161) in the 2007–2012 National Health and Nutrition Examination Surveys were analyzed. Random glucose and survey data were used to assemble the random glucose, American Diabetes Association (ADA), and U.S. Preventive Services Task Force (USPSTF) screening strategies and predict diabetes using hemoglobin A1c criteria. Results Using random glucose ≥100 mg/dL to select individuals for diabetes testing was 81.6% (95% CI=74.9%, 88.4%) sensitive, 78% (95% CI=76.6%, 79.5%) specific and had an area under the receiver operating curve (AROC) of 0.80 (95% CI=0.78, 0.83) to detect undiagnosed diabetes. Overall performance of ADA (AROC=0.59, 95% CI=0.58, 0.60), 2008 USPSTF (AROC=0.62, 95% CI=0.59, 0.65), and 2015 USPSTF (AROC=0.64, 95% CI=0.61, 0.67) guidelines was similar. The random glucose strategy correctly identified one case of undiagnosed diabetes for every 14 people screened, which was more efficient than ADA (number needed to screen, 35), 2008 USPSTF (44), and 2015 USPSTF (32) guidelines. Conclusions Using random glucose ≥100 mg/dL to identify individuals in need of diabetes screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection. Further evaluation of this strategy's effectiveness in real-world clinical practice is needed.
UR - http://www.scopus.com/inward/record.url?scp=85014463999&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014463999&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2017.01.023
DO - 10.1016/j.amepre.2017.01.023
M3 - Article
C2 - 28279547
AN - SCOPUS:85014463999
SN - 0749-3797
VL - 52
SP - 710
EP - 716
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 6
ER -