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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

Modelling the screening outcome in a community with 1000 adult population.*One Step strategy = Direct invitation to OGTT (Studies in Table 1). **Two- Step strategy = One step screen before OGTT (Studies in Table 2). ***Three/Four Step Studies = Two or three screening steps before OGTT (Studies in Table 2).
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pone.0135702.g005: Modelling the screening outcome in a community with 1000 adult population.*One Step strategy = Direct invitation to OGTT (Studies in Table 1). **Two- Step strategy = One step screen before OGTT (Studies in Table 2). ***Three/Four Step Studies = Two or three screening steps before OGTT (Studies in Table 2).

Mentions: We applied the mean response and yield rates from the meta-analysis to a hypothetical population of 1000 individuals in order to determine the diagnostic yield of the three screening strategies (Fig 5). The number of individuals screened using OGTT decreased from 650 in a one-step strategy to 156 and 45 in two-step and three/four-step screening strategies respectively, and the number of T2DM cases identified decreased from 42 cases in one-step strategy to 28 and 18 in the two-step and three/four-step strategies respectively.


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)

Modelling the screening outcome in a community with 1000 adult population.*One Step strategy = Direct invitation to OGTT (Studies in Table 1). **Two- Step strategy = One step screen before OGTT (Studies in Table 2). ***Three/Four Step Studies = Two or three screening steps before OGTT (Studies in Table 2).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0135702.g005: Modelling the screening outcome in a community with 1000 adult population.*One Step strategy = Direct invitation to OGTT (Studies in Table 1). **Two- Step strategy = One step screen before OGTT (Studies in Table 2). ***Three/Four Step Studies = Two or three screening steps before OGTT (Studies in Table 2).
Mentions: We applied the mean response and yield rates from the meta-analysis to a hypothetical population of 1000 individuals in order to determine the diagnostic yield of the three screening strategies (Fig 5). The number of individuals screened using OGTT decreased from 650 in a one-step strategy to 156 and 45 in two-step and three/four-step screening strategies respectively, and the number of T2DM cases identified decreased from 42 cases in one-step strategy to 28 and 18 in the two-step and three/four-step strategies respectively.

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