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Detection of undiagnosed diabetes and other hyperglycemia states: the Atherosclerosis Risk in Communities Study.

TitleDetection of undiagnosed diabetes and other hyperglycemia states: the Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2003
AuthorsSchmidt M I, Duncan BB, Vigo A, Pankow J, Ballantyne CM, Couper D, Brancati F, Folsom AR
Corporate AuthorsARIC Investigators
JournalDiabetes Care
Volume26
Issue5
Pagination1338-43
Date Published2003 May
ISSN0149-5992
KeywordsAged, Blood Glucose, Continental Population Groups, Diabetes Mellitus, Diabetes Mellitus, Type 2, Fasting, Female, Glucose Tolerance Test, Humans, Hyperglycemia, Male, Middle Aged, Probability, United States
Abstract

OBJECTIVE: To evaluate screening strategies based on fasting plasma glucose (FPG), clinical information, and the oral glucose tolerance test (OGTT) for detection of diabetes or other hyperglycemic states-impaired fasting glucose (IFG) and impaired glucose tolerance-meriting clinical intervention.

RESEARCH DESIGN AND METHODS: We studied 8,286 African-American and white men and women without known diabetes, aged 53-75 years, who received an OGTT during the fourth exam of the Atherosclerosis Risk in Communities Study. Using a split sample technique, we estimated the diagnostic properties of various clinical detection rules derived from logistic regression modeling. Screening strategies utilizing FPG, these detection rules, and/or the OGTT were then compared in terms of both the fraction of hyperglycemia cases detected and the sample fraction receiving different screening tests and identified as screen positive.

RESULTS: Screening based on the IFG cut point (> or =6.1 mmol/l), followed by a clinical detection rule for those below this value, detected 86.3% of diabetic case subjects and 66.0% of all hyperglycemia cases, identifying 42% of the sample as screen positive. Applying an OGTT for those positive by the rule provides diagnostic labeling and reduces the fraction that is screen positive to 29%. Another strategy, to apply an OGTT to those with an FPG cut point between 5.6 and 6.1 mmol/l, also identifies 29% of the sample as screen positive, although it detects slightly fewer hyperglycemia cases.

CONCLUSIONS: Screening strategies based on FPG, complemented by clinical detection rules and/or an OGTT, are effective and practical in the detection of hyperglycemic states meriting clinical intervention.

DOI10.2337/diacare.26.5.1338
Alternate JournalDiabetes Care
PubMed ID12716785
Grant List5R01-DK56918-03 / DK / NIDDK NIH HHS / United States
N01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States