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Age, BMI, and Race Are Less Important Than Random Plasma Glucose in Identifying Risk of Glucose Intolerance

The Screening for Impaired Glucose Tolerance Study (SIGT 5)

¹ Division of Endocrinology and Metabolism, Emory University, Atlanta, Georgia
² Christiana Care Health System, Newark, Delaware
³ Division of Cardiology, Emory University, Atlanta, Georgia
⁴ Department of Pathology & Laboratory Medicine, Emory University, Atlanta, Georgia
⁵ Department of Medicine, Emory University, Atlanta, Georgia
⁶ Hubert Department of Global Health, Emory University, Atlanta, Georgia
⁷ Veterans Administration Medical Center, Atlanta, Georgia

Corresponding author: Lawrence S. Phillips, MD, Endocrinology, Emory University, 101 Woodruff Circle, WMRB Room 1027, Atlanta, GA 30322. E-mail: medlsp{at}emory.edu

OBJECTIVE—Age, BMI, and race/ethnicity are used in National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and American Diabetes Association (ADA) guidelines to prompt screening for pre-diabetes and diabetes, but cutoffs have not been evaluated rigorously.

RESEARCH DESIGN AND METHODS—Random plasma glucose (RPG) was measured and 75-g oral glucose tolerance tests were performed in 1,139 individuals without known diabetes. Screening performance was assessed by logistic regression and area under the receiver operating characteristic curve (AROC).

RESULTS—NIDDK/ADA indicators age >45 years and BMI >25 kg/m² provided significant detection of both diabetes and dysglycemia (both AROCs 0.63), but screening was better with continuous-variable models of age, BMI, and race and better still with models of age, BMI, race, sex, and family history (AROC 0.78 and 0.72). However, screening was even better with RPG alone (AROCs 0.81 and 0.72). RPG >125 mg/dl could be used to prompt further evaluation with an OGTT.

CONCLUSIONS—Use of age, BMI, and race/ethnicity in guidelines for screening to detect diabetes and pre-diabetes may be less important than evaluation of RPG. RPG should be investigated further as a convenient, inexpensive screen with good predictive utility.

Abbreviations: ADA, American Diabetes Association • AROC, area under the receiver operating characteristic curve • IGT, impaired glucose tolerance • NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases • OGTT, oral glucose tolerance test • RPG, random plasma glucose

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