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Systematic Review and Meta-Analysis of Response Rates and Diagnostic Yield of Screening for Type 2 Diabetes and Those at High Risk of Diabetes.

Khunti K, Mani H, Achana F, Cooper N, Gray LJ, Davies MJ - PLoS ONE (2015)

Bottom Line: In two step strategies, there was no difference between the response or yield rates whether the first step was blood test or risk-score.There was evidence of substantial heterogeneity in rates across study populations but this was not explained by the method of invitation, study location (rural versus urban) and developmental index of the country in which the study was performed.Irrespective of the invitation method, developmental status of the countries and or rural/urban location, using a multi-step strategy increases the initial response rate to the invitation to screening for diabetes and reduces the number needed to have the final diagnostic test (OGTT in this study) for a definite diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom.

ABSTRACT

Background: Screening for type 2 diabetes (T2DM) and individuals at risk of diabetes has been advocated, yet information on the response rate and diagnostic yield of different screening strategies are lacking.

Methods: Studies (from 1998 to March/2015) were identified through Medline, Embase and the Cochrane library and included if they used oral glucose tolerance test (OGTT) and WHO-1998 diagnostic criteria for screening in a community setting. Studies were one-step strategy if participants were invited directly for OGTT and two, three/four step if participants were screened at one or more levels prior to invitation to OGTT. The response rate and diagnostic yield were pooled using Bayesian random-effect meta-analyses.

Findings: 47 studies (422754 participants); 29 one-step, 11 two-step and seven three/four-step were identified. Pooled response rate (95% Credible Interval) for invitation to OGTT was 65.5% (53.7, 75.6), 63.1% (44.0, 76.8), and 85.4% (76.4, 93.3) in one, two and three/four-step studies respectively. T2DM yield was 6.6% (5.3, 7.8), 13.1% (4.3, 30.9) and 27.9% (8.6, 66.3) for one, two and three/four-step strategies respectively. The number needed to invite to the OGTT to detect one case of T2DM was 15, 7.6 and 3.6 in one, two, and three/four-step strategies. In two step strategies, there was no difference between the response or yield rates whether the first step was blood test or risk-score. There was evidence of substantial heterogeneity in rates across study populations but this was not explained by the method of invitation, study location (rural versus urban) and developmental index of the country in which the study was performed.

Conclusions: Irrespective of the invitation method, developmental status of the countries and or rural/urban location, using a multi-step strategy increases the initial response rate to the invitation to screening for diabetes and reduces the number needed to have the final diagnostic test (OGTT in this study) for a definite diagnosis.

No MeSH data available.


Related in: MedlinePlus

Pooled response rates to diabetes screening invitation.Estimates are from Bayesian random effects meta-analysis. CrI = Credible intervals which is similar to a confidence intervals generated using Frequentist statistics.
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pone.0135702.g002: Pooled response rates to diabetes screening invitation.Estimates are from Bayesian random effects meta-analysis. CrI = Credible intervals which is similar to a confidence intervals generated using Frequentist statistics.

Mentions: Estimates of pooled screening response rates are presented in Fig 2. The response rate for OGTT as a proportion of those invited for OGTT was similar in studies using one-step and two-step strategies at approximately 65% and higher in studies using a three/four-step strategy at 85·4%. Among the studies using a multi-step screening strategy, the response rate to the initial screening invitation was 79·5% for the two-step strategy which is higher than the estimated 55·4% response the rate for studies using three/four-step strategy but there was considerable overlap in the uncertainty (i.e. 95% credible intervals) around these estimates (Fig 1). Only the studies using a three/four-step strategy had an intermediate screening step which had a pooled response rate of 69·7%.


Systematic Review and Meta-Analysis of Response Rates and Diagnostic Yield of Screening for Type 2 Diabetes and Those at High Risk of Diabetes.

Khunti K, Mani H, Achana F, Cooper N, Gray LJ, Davies MJ - PLoS ONE (2015)

Pooled response rates to diabetes screening invitation.Estimates are from Bayesian random effects meta-analysis. CrI = Credible intervals which is similar to a confidence intervals generated using Frequentist statistics.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556656&req=5

pone.0135702.g002: Pooled response rates to diabetes screening invitation.Estimates are from Bayesian random effects meta-analysis. CrI = Credible intervals which is similar to a confidence intervals generated using Frequentist statistics.
Mentions: Estimates of pooled screening response rates are presented in Fig 2. The response rate for OGTT as a proportion of those invited for OGTT was similar in studies using one-step and two-step strategies at approximately 65% and higher in studies using a three/four-step strategy at 85·4%. Among the studies using a multi-step screening strategy, the response rate to the initial screening invitation was 79·5% for the two-step strategy which is higher than the estimated 55·4% response the rate for studies using three/four-step strategy but there was considerable overlap in the uncertainty (i.e. 95% credible intervals) around these estimates (Fig 1). Only the studies using a three/four-step strategy had an intermediate screening step which had a pooled response rate of 69·7%.

Bottom Line: In two step strategies, there was no difference between the response or yield rates whether the first step was blood test or risk-score.There was evidence of substantial heterogeneity in rates across study populations but this was not explained by the method of invitation, study location (rural versus urban) and developmental index of the country in which the study was performed.Irrespective of the invitation method, developmental status of the countries and or rural/urban location, using a multi-step strategy increases the initial response rate to the invitation to screening for diabetes and reduces the number needed to have the final diagnostic test (OGTT in this study) for a definite diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom.

ABSTRACT

Background: Screening for type 2 diabetes (T2DM) and individuals at risk of diabetes has been advocated, yet information on the response rate and diagnostic yield of different screening strategies are lacking.

Methods: Studies (from 1998 to March/2015) were identified through Medline, Embase and the Cochrane library and included if they used oral glucose tolerance test (OGTT) and WHO-1998 diagnostic criteria for screening in a community setting. Studies were one-step strategy if participants were invited directly for OGTT and two, three/four step if participants were screened at one or more levels prior to invitation to OGTT. The response rate and diagnostic yield were pooled using Bayesian random-effect meta-analyses.

Findings: 47 studies (422754 participants); 29 one-step, 11 two-step and seven three/four-step were identified. Pooled response rate (95% Credible Interval) for invitation to OGTT was 65.5% (53.7, 75.6), 63.1% (44.0, 76.8), and 85.4% (76.4, 93.3) in one, two and three/four-step studies respectively. T2DM yield was 6.6% (5.3, 7.8), 13.1% (4.3, 30.9) and 27.9% (8.6, 66.3) for one, two and three/four-step strategies respectively. The number needed to invite to the OGTT to detect one case of T2DM was 15, 7.6 and 3.6 in one, two, and three/four-step strategies. In two step strategies, there was no difference between the response or yield rates whether the first step was blood test or risk-score. There was evidence of substantial heterogeneity in rates across study populations but this was not explained by the method of invitation, study location (rural versus urban) and developmental index of the country in which the study was performed.

Conclusions: Irrespective of the invitation method, developmental status of the countries and or rural/urban location, using a multi-step strategy increases the initial response rate to the invitation to screening for diabetes and reduces the number needed to have the final diagnostic test (OGTT in this study) for a definite diagnosis.

No MeSH data available.


Related in: MedlinePlus