Diabetes mellitus type 2 screening: Difference between revisions
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==== Accuracy of Tests for Early Detection ==== | ==== Accuracy of Tests for Early Detection ==== | ||
If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid12558362"/>: | If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid12558362"/>: | ||
* [[sensitivity (tests)| | * [[sensitivity (tests)|Sensitivity]] about 50% | ||
* [[specificity (tests)| | * [[specificity (tests)|Specificity]] greater than 95% | ||
A ''random'' capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid11679454">{{cite journal |author=Rolka DB, Narayan KM, Thompson TJ, ''et al'' |title=Performance of recommended screening tests for undiagnosed diabetes and dysglycemia |journal=Diabetes Care |volume=24 |issue=11 |pages=1899-903 |year=2001 |pmid=11679454 |doi=}}</ref>: | A ''random'' capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses ''current'' diabetes with<ref name="pmid11679454">{{cite journal |author=Rolka DB, Narayan KM, Thompson TJ, ''et al'' |title=Performance of recommended screening tests for undiagnosed diabetes and dysglycemia |journal=Diabetes Care |volume=24 |issue=11 |pages=1899-903 |year=2001 |pmid=11679454 |doi=}}</ref>: | ||
* [[sensitivity (tests)| | * [[sensitivity (tests)|Sensitivity]] = 75% | ||
* [[specificity (tests)| | * [[specificity (tests)|Specificity]] = 88% | ||
[[Glycosylated hemoglobin]] values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of ''subsequent'' clinical diabetes in US female health professionals.<ref name="pmid17679132">{{cite journal |author=Pradhan AD, Rifai N, Buring JE, Ridker PM |title=Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women |journal=Am. J. Med. |volume=120 |issue=8 |pages=720-7 |year=2007 |pmid=17679132 |doi=10.1016/j.amjmed.2007.03.022}}</ref> In this study, 177 of 1061 patients with [[glycosylated hemoglobin]] value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a [[glycosylated hemoglobin]] value of 6.0% or more. This equates to a [[glycosylated hemoglobin]] value of 6.0% or more having: | [[Glycosylated hemoglobin]] values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of ''subsequent'' clinical diabetes in US female health professionals.<ref name="pmid17679132">{{cite journal |author=Pradhan AD, Rifai N, Buring JE, Ridker PM |title=Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women |journal=Am. J. Med. |volume=120 |issue=8 |pages=720-7 |year=2007 |pmid=17679132 |doi=10.1016/j.amjmed.2007.03.022}}</ref> In this study, 177 of 1061 patients with [[glycosylated hemoglobin]] value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a [[glycosylated hemoglobin]] value of 6.0% or more. This equates to a [[glycosylated hemoglobin]] value of 6.0% or more having: | ||
* [[sensitivity (tests)| | * [[sensitivity (tests)|Sensitivity]] = 16.7% | ||
* [[specificity (tests)| | * [[specificity (tests)|Specificity]] = 98.9% | ||
===Benefit of Early Detection=== | ===Benefit of Early Detection=== | ||
Revision as of 15:31, 21 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]
Screening
Practice Guidelines
U.S. Preventive Services Task Force
Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the U.S. Preventive Services Task Force (USPSTF) concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"[1][2], this was a grade I recommendation when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia (grade B recommendation).
In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".[3]
Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care recommends the following frequency of screening with glycosylated hemoglobin A based on risk estimated by the Finnish Diabetes Risk Score else Canadian Diabetes Risk Assessment Questionnaire]:[4]
- Very high risk or prediabetes (50% within 10 years) - Finnish Diabetes Risk Score > 20: screen annually
- High risk (33% within 10 years) - Finnish Diabetes Risk Score 15 to 20: screen every 3–5 years
Evidence
Accuracy of Tests for Early Detection
If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses current diabetes with[2]:
- Sensitivity about 50%
- Specificity greater than 95%
A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses current diabetes with[5]:
- Sensitivity = 75%
- Specificity = 88%
Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of subsequent clinical diabetes in US female health professionals.[6] In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having:
- Sensitivity = 16.7%
- Specificity = 98.9%
Benefit of Early Detection
Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarbose to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event[7].
Other studies have shown that life-style changes[8] and metformin[9] can delay the onset of diabetes.
References
- ↑ U.S. Preventive Services Task Force (2003). "Screening for type 2 diabetes mellitus in adults: recommendations and rationale". Ann. Intern. Med. 138 (3): 212–4. PMID 12558361. National Guidelines Clearinghouse: Complete Summary
- ↑ 2.0 2.1 Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN (2003). "Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force". Ann. Intern. Med. 138 (3): 215–29. PMID 12558362.
- ↑ Santaguida PL, Balion C, Hunt D; et al. (2005). "Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose". Evidence report/technology assessment (Summary) (128): 1–11. PMID 16194123.
- ↑ Care, Canadian Task Force on Preventive Health (2012-10-16). "Recommendations on screening for type 2 diabetes in adults". Canadian Medical Association Journal. 184 (15): 1687–1696. doi:10.1503/cmaj.120732. ISSN 1488-2329 0820-3946, 1488-2329 Check
|issn=value (help). Retrieved 2012-10-17. - ↑ Rolka DB, Narayan KM, Thompson TJ; et al. (2001). "Performance of recommended screening tests for undiagnosed diabetes and dysglycemia". Diabetes Care. 24 (11): 1899–903. PMID 11679454.
- ↑ Pradhan AD, Rifai N, Buring JE, Ridker PM (2007). "Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women". Am. J. Med. 120 (8): 720–7. doi:10.1016/j.amjmed.2007.03.022. PMID 17679132.
- ↑ Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2003). "Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial". JAMA. 290 (4): 486–94. doi:10.1001/jama.290.4.486. PMID 12876091. ACP Journal Club review
- ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.ACP Journal Club review
- ↑ Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N. Engl. J. Med. 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMID 11832527. ACP Journal Club review