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Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.

Bao C, Zhang D, Sun B, Lan L, Cui W, Xu G, Sui C, Wang Y, Zhao Y, Wang J, Li H - PLoS ONE (2015)

Bottom Line: Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described.Approximately a quarter of the general population in Harbin was in hyperglycemic condition.Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.

ABSTRACT
To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

No MeSH data available.


Related in: MedlinePlus

The total cost per case identified by two-step strategy at different FPG cut-points for further OGTT test.In Fig.1A, further OGTT was not conducted for subjects with FPG ≥5.6 mmol/l (≥6.1mmol/l) in the case of screening for both diabetes and pre-diabetes using ADA criteria (WHO criteria). In Fig.1B and 1C, further OGTT was not conducted for subjects with FPG ≥7.0 mmol/l in the case of screening for undiagnosed diabetes or both diabetes and pre-diabetes or pre-diabetes alone or IGT.
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pone.0119510.g001: The total cost per case identified by two-step strategy at different FPG cut-points for further OGTT test.In Fig.1A, further OGTT was not conducted for subjects with FPG ≥5.6 mmol/l (≥6.1mmol/l) in the case of screening for both diabetes and pre-diabetes using ADA criteria (WHO criteria). In Fig.1B and 1C, further OGTT was not conducted for subjects with FPG ≥7.0 mmol/l in the case of screening for undiagnosed diabetes or both diabetes and pre-diabetes or pre-diabetes alone or IGT.

Mentions: The optimal FPG cut-off points were 5.6 mmol/l for previously undiagnosed diabetes, 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes using ADA criteria, 5.0 mmol/l for pre-diabetes using WHO criteria, and 4.9 mmol/l for IGT. The AUCs and sensitivities of these points were lower for FPG than for 2-h PG in screening both diabetes and pre-diabetes, undiagnosed diabetes, and pre-diabetes.(Table 1 and S3 Table) Nevertheless, the AUCs for FPG (sensitivity, Specificity) were greater than 0.7 (60%, 70%), and Kappa values between optimal FPG cut-off points and gold standards were statistically significant (P <0.001). Therefore further OGTT (two-step strategy) should be conducted to increase specificity for screening diabetes and/or pre-diabetes. Using the optimal FPG cut-off points for screening pre-diabetes using WHO criteria or IGT alone, Kappa values (<0.4) and specificity (<80%) were lower, and OGTT alone (one-step strategy) should be better conducted.(Table 1) The total costs per case of these points were relatively lower.(Fig. 1) 5.6 mmol/l for previously undiagnosed diabetes and 5.3 mmol/l for both diabetes and pre-diabetes using ADA criteria were with the least medical cost per case. Medical and total cost per case of these points were both diabetes and pre-diabetes (ADA criteria), ¥51, ¥110, both diabetes and pre-diabetes (WHO criteria), ¥69, ¥154, pre-diabetes alone (ADA criteria), ¥112, ¥258, diabetes alone, ¥117, ¥261, pre-diabetes alone (WHO criteria), ¥166, ¥399, IGT alone, ¥205, ¥502, ascendingly.(S4 Table) The optimal FPG cut-off points for previously undiagnosed diabetes were 5.3 mmol/l (sensitivity 86.1%; specificity 81.5%) at age 60–74 years and 5.6 mmol/l at age<60 years (sensitivity 84.6%; specificity 92.1%), respectively. The optimal FPG cut-off points for IGT were 4.9 mmol/l in men (sensitivity 60.5%, specificity 73.2%) and women (sensitivity 62.2%, specificity 75.2%).


Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.

Bao C, Zhang D, Sun B, Lan L, Cui W, Xu G, Sui C, Wang Y, Zhao Y, Wang J, Li H - PLoS ONE (2015)

The total cost per case identified by two-step strategy at different FPG cut-points for further OGTT test.In Fig.1A, further OGTT was not conducted for subjects with FPG ≥5.6 mmol/l (≥6.1mmol/l) in the case of screening for both diabetes and pre-diabetes using ADA criteria (WHO criteria). In Fig.1B and 1C, further OGTT was not conducted for subjects with FPG ≥7.0 mmol/l in the case of screening for undiagnosed diabetes or both diabetes and pre-diabetes or pre-diabetes alone or IGT.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4364753&req=5

pone.0119510.g001: The total cost per case identified by two-step strategy at different FPG cut-points for further OGTT test.In Fig.1A, further OGTT was not conducted for subjects with FPG ≥5.6 mmol/l (≥6.1mmol/l) in the case of screening for both diabetes and pre-diabetes using ADA criteria (WHO criteria). In Fig.1B and 1C, further OGTT was not conducted for subjects with FPG ≥7.0 mmol/l in the case of screening for undiagnosed diabetes or both diabetes and pre-diabetes or pre-diabetes alone or IGT.
Mentions: The optimal FPG cut-off points were 5.6 mmol/l for previously undiagnosed diabetes, 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes using ADA criteria, 5.0 mmol/l for pre-diabetes using WHO criteria, and 4.9 mmol/l for IGT. The AUCs and sensitivities of these points were lower for FPG than for 2-h PG in screening both diabetes and pre-diabetes, undiagnosed diabetes, and pre-diabetes.(Table 1 and S3 Table) Nevertheless, the AUCs for FPG (sensitivity, Specificity) were greater than 0.7 (60%, 70%), and Kappa values between optimal FPG cut-off points and gold standards were statistically significant (P <0.001). Therefore further OGTT (two-step strategy) should be conducted to increase specificity for screening diabetes and/or pre-diabetes. Using the optimal FPG cut-off points for screening pre-diabetes using WHO criteria or IGT alone, Kappa values (<0.4) and specificity (<80%) were lower, and OGTT alone (one-step strategy) should be better conducted.(Table 1) The total costs per case of these points were relatively lower.(Fig. 1) 5.6 mmol/l for previously undiagnosed diabetes and 5.3 mmol/l for both diabetes and pre-diabetes using ADA criteria were with the least medical cost per case. Medical and total cost per case of these points were both diabetes and pre-diabetes (ADA criteria), ¥51, ¥110, both diabetes and pre-diabetes (WHO criteria), ¥69, ¥154, pre-diabetes alone (ADA criteria), ¥112, ¥258, diabetes alone, ¥117, ¥261, pre-diabetes alone (WHO criteria), ¥166, ¥399, IGT alone, ¥205, ¥502, ascendingly.(S4 Table) The optimal FPG cut-off points for previously undiagnosed diabetes were 5.3 mmol/l (sensitivity 86.1%; specificity 81.5%) at age 60–74 years and 5.6 mmol/l at age<60 years (sensitivity 84.6%; specificity 92.1%), respectively. The optimal FPG cut-off points for IGT were 4.9 mmol/l in men (sensitivity 60.5%, specificity 73.2%) and women (sensitivity 62.2%, specificity 75.2%).

Bottom Line: Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described.Approximately a quarter of the general population in Harbin was in hyperglycemic condition.Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.

ABSTRACT
To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

No MeSH data available.


Related in: MedlinePlus