RT Journal Article
SR Electronic
T1 The Efficacy and Cost of Alternative Strategies for Systematic Screening for Type 2 Diabetes in the U.S. Population 45–74 Years of Age
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 307
OP 311
DO 10.2337/diacare.28.2.307
VO 28
IS 2
A1 Johnson, Susan L.
A1 Tabaei, Bahman P.
A1 Herman, William H.
YR 2005
UL http://care.diabetesjournals.org/content/28/2/307.abstract
AB OBJECTIVE—To simulate the outcomes of alternative strategies for screening the U.S. population 45–74 years of age for type 2 diabetes. RESEARCH DESIGN AND METHODS—We simulated screening with random plasma glucose (RPG) and cut points of 100, 130, and 160 mg/dl and a multivariate equation including RPG and other variables. Over 15 years, we simulated screening at intervals of 1, 3, and 5 years. All positive screening tests were followed by a diagnostic fasting plasma glucose or an oral glucose tolerance test. Outcomes include the numbers of false-negative, true-positive, and false-positive screening tests and the direct and indirect costs. RESULTS— At year 15, screening every 3 years with an RPG cut point of 100 mg/dl left 0.2 million false negatives, an RPG of 130 mg/dl or the equation left 1.3 million false negatives, and an RPG of 160 mg/dl left 2.8 million false negatives. Over 15 years, the absolute difference between the most sensitive and most specific screening strategy was 4.5 million true positives and 476 million false-positives. Strategies using RPG cut points of 130 mg/dl or the multivariate equation every 3 years identified 17.3 million true positives; however, the equation identified fewer false-positives. The total cost of the most sensitive screening strategy was $42.7 billion and that of the most specific strategy was $6.9 billion. CONCLUSIONS— Screening for type 2 diabetes every 3 years with an RPG cut point of 130 mg/dl or the multivariate equation provides good yield and minimizes false-positive screening tests and costs.