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Opportunistic Screening for Diabetes in Routine Clinical Practice

¹ Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Michigan Health System, Ann Arbor, Michigan
² Michigan Diabetes Research and Training Center, University of Michigan Health System, Ann Arbor, Michigan
³ Department of Epidemiology, Division of Endocrinology and Metabolism, University of Michigan Health System, Ann Arbor, Michigan

Address correspondence and reprint requests to William H. Herman, MD, MPH, Division of Endocrinology and Metabolism, Departments of Internal Medicine and Epidemiology and the Michigan Diabetes Research and Training Center, University of Michigan Health System, 1500 E. Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354. E-mail: wherman{at}umich.edu

OBJECTIVE—Since 1997, the American Diabetes Association has recommended that nondiabetic individuals 45 years of age be screened for diabetes at least every 3 years. We sought to characterize the frequency, methods, and results of diabetes screening in routine clinical practice.

RESEARCH DESIGN AND METHODS—We studied opportunistic screening in nondiabetic members of a health maintenance organization 45 years of age who were assigned to a large, integrated, academic health care delivery system. Screening was defined as the first glucose, HbA_1c, or oral glucose tolerance test (OGTT) performed between 1 January 1998 and 31 December 2000. Chart review was performed to determine the prevalence of diabetes risk factors and to describe follow-up.

RESULTS—Of 8,286 nondiabetic patients 45 years of age, 69% (n = 5,752) were screened. The frequency of screening was greater in patients with one or more primary care visits and increased with age. Women were more likely to be screened than men, and patients with at least one diabetes risk factor were more likely to be screened than those without risk factors. Random plasma glucose was the most common screening test (95%). Four percent (n = 202) of those screened had abnormal results. Only 38% (n = 77) of those with abnormal results received appropriate follow-up, and 17% (n = 35) were diagnosed with diabetes within 6 months of screening. The yield of screening was very low (0.6%, 35 of 5,752).

CONCLUSIONS—Despite frequent screening and appropriate targeting of high-risk patients, follow-up of patients with abnormal results is uncommon and the yield of screening is low. Interventions are needed to help physicians recognize and provide appropriate follow-up for patients with potentially abnormal random glucose levels.

Abbreviations: ADA, American Diabetes Association • OGTT, oral glucose tolerance test • UMHS, University of Michigan Health System

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