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Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population

¹ Social and Scientific Systems, Silver Spring, Maryland
² National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland

OBJECTIVE—To determine the feasibility of using either fasting plasma glucose or HbA_1c to identify individuals in the U.S. population who meet the Diabetes Prevention Program (DPP) criteria for intervention, defined as BMI 24 kg/m², fasting plasma glucose level 96–125 mg/dl, and 2-h glucose level 140–199 mg/dl in an oral glucose tolerance test (OGTT).

RESEARCH DESIGN AND METHODS—Analysis of a representative sample of U.S. adults aged 40–74 years with no medical history of diabetes for whom data on height, weight, fasting plasma glucose, HbA_1c, and 2-h plasma glucose during an OGTT were obtained. Sensitivity, specificity, positive predictive value (PPV), and receiver operator characteristic (ROC) curves for fasting glucose and HbA_1c were determined.

RESULTS—Using BMI <24 kg/m² as an initial criterion eliminated 27.2% of U.S. adults from further testing. Of the remaining group, 41.1% did not have to be considered for an OGTT because their fasting glucose level was below or above 96–125 mg/dl. Overall, 10.6% of adults aged 40–74 years without medical history of diabetes met the DPP eligibility criteria for intervention. Among individuals with BMI 24 kg/m² and fasting glucose level 96–125 mg/dl, applying a fasting plasma glucose cutoff of 105 mg/dl excluded 62.5% of this group and resulted in 56.0% of those with 2-h glucose level 140–199 mg/dl in this group being identified, with a specificity of 72.0% and a PPV of 17.1%. Similar values were obtained for an HbA_1c cutoff value of 5.5%.

CONCLUSIONS—Using data on BMI and setting cutoff values for fasting glucose and HbA_1c would greatly reduce the number of individuals who would need to undergo an OGTT while achieving adequate sensitivity, specificity, and PPV.

Abbreviations: DPP, Diabetes Prevention Program • NHANES III, third National Health and Nutrition Examination Survey • OGTT, oral glucose tolerance test • PPV, positive predictive value • ROC, receiver operator characteristic

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