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Screening for diabetes mellitus--a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications.
Diabet Med. 2000 Nov; 17(11):771-5.DM

Abstract

AIMS

To compare the new American Diabetes Association (ADA) fasting plasma glucose (FPG) criteria to the 1985 World Health Organization (WHO) 2-h post glucose (2hPG) criteria when used for screening of those with no prior history of diabetes mellitus.

METHODS

The study included 3,407 subjects without a history of diabetes in whom both FPG and 2hPG were available from the 1992 Singapore National Health Survey. The agreement (kappa) between FPG and 2hPG for the diagnosis of DM was assessed. The optimal cut-off of FPG for the detection of individuals with 2hPG > or = 11.1 mmol/l was determined by receiver-operating characteristics analysis.

RESULTS

The prevalence of diabetes diagnosed by FPG alone was 7.3% compared to 8.4% diagnosed by 2hPG. The prevalence of impaired fasting glucose was 8.0%. FPG and 2hPG showed moderate agreement (kappa = 0.646, 95% confidence interval 0.584-0.708). Age, ethnic group and obesity did not affect the degree of agreement. Of those with 2hPG > or = 11.1 mmol/l, 40.8% had FPG in the non-diabetic range while 24.8% of those with FG > or = 7.0 mmol/l had 2hPG in the non-diabetic range. The optimal FPG for the detection of 2hPG > or =11.1 mmol/l was 6.1 mmol/l. Oral glucose tolerance tests (OGTT) in those with 6.0 mmol/ < FPG < 7.0 mmol/l resulted in the diagnosis of diabetes in 90.7% of individuals at risk of microvascular complications.

CONCLUSIONS

FPG provides a simple screening test for diabetes, which shows moderate agreement with the 2hPG. A two-step strategy of OGTT in those with impaired fasting glucose improves the detection of at-risk individuals. However, diabetes should not be diagnosed on a single test. The test should be repeated on another day if an individual tests positive for diabetes.

Authors+Show Affiliations

Department of Endocrinology, Singapore General Hospital, Singapore. eshyong@pacific.net.sgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11131101

Citation

Tai, E S., et al. "Screening for Diabetes Mellitus--a Two-step Approach in Individuals With Impaired Fasting Glucose Improves Detection of Those at Risk of Complications." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 17, no. 11, 2000, pp. 771-5.
Tai ES, Lim SC, Tan BY, et al. Screening for diabetes mellitus--a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications. Diabet Med. 2000;17(11):771-5.
Tai, E. S., Lim, S. C., Tan, B. Y., Chew, S. K., Heng, D., & Tan, C. E. (2000). Screening for diabetes mellitus--a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications. Diabetic Medicine : a Journal of the British Diabetic Association, 17(11), 771-5.
Tai ES, et al. Screening for Diabetes Mellitus--a Two-step Approach in Individuals With Impaired Fasting Glucose Improves Detection of Those at Risk of Complications. Diabet Med. 2000;17(11):771-5. PubMed PMID: 11131101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for diabetes mellitus--a two-step approach in individuals with impaired fasting glucose improves detection of those at risk of complications. AU - Tai,E S, AU - Lim,S C, AU - Tan,B Y, AU - Chew,S K, AU - Heng,D, AU - Tan,C E, PY - 2000/12/29/pubmed PY - 2001/3/10/medline PY - 2000/12/29/entrez SP - 771 EP - 5 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 17 IS - 11 N2 - AIMS: To compare the new American Diabetes Association (ADA) fasting plasma glucose (FPG) criteria to the 1985 World Health Organization (WHO) 2-h post glucose (2hPG) criteria when used for screening of those with no prior history of diabetes mellitus. METHODS: The study included 3,407 subjects without a history of diabetes in whom both FPG and 2hPG were available from the 1992 Singapore National Health Survey. The agreement (kappa) between FPG and 2hPG for the diagnosis of DM was assessed. The optimal cut-off of FPG for the detection of individuals with 2hPG > or = 11.1 mmol/l was determined by receiver-operating characteristics analysis. RESULTS: The prevalence of diabetes diagnosed by FPG alone was 7.3% compared to 8.4% diagnosed by 2hPG. The prevalence of impaired fasting glucose was 8.0%. FPG and 2hPG showed moderate agreement (kappa = 0.646, 95% confidence interval 0.584-0.708). Age, ethnic group and obesity did not affect the degree of agreement. Of those with 2hPG > or = 11.1 mmol/l, 40.8% had FPG in the non-diabetic range while 24.8% of those with FG > or = 7.0 mmol/l had 2hPG in the non-diabetic range. The optimal FPG for the detection of 2hPG > or =11.1 mmol/l was 6.1 mmol/l. Oral glucose tolerance tests (OGTT) in those with 6.0 mmol/ < FPG < 7.0 mmol/l resulted in the diagnosis of diabetes in 90.7% of individuals at risk of microvascular complications. CONCLUSIONS: FPG provides a simple screening test for diabetes, which shows moderate agreement with the 2hPG. A two-step strategy of OGTT in those with impaired fasting glucose improves the detection of at-risk individuals. However, diabetes should not be diagnosed on a single test. The test should be repeated on another day if an individual tests positive for diabetes. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/11131101/Screening_for_diabetes_mellitus__a_two_step_approach_in_individuals_with_impaired_fasting_glucose_improves_detection_of_those_at_risk_of_complications_ DB - PRIME DP - Unbound Medicine ER -