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Diabetes screening intervals based on risk stratification

View Article: PubMed Central - PubMed

ABSTRACT

Background: Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes.

Methods: This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals based on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We adapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a linear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1.

Results: Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48 (30–74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30–44 years old, HbA1c screening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMI > 30) years, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ≥20%) years. This trend was consistent in other age and risk groups as well; among obese 30–44 year olds, we found substantially shorter intervals compared to other groups.

Conclusion: HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk stratification should be applied when deciding an optimal HbA1c screening interval in the general population to minimize overdiagnosis and overtreatment.

No MeSH data available.


DM screening intervals for Hba1c screening test by Framingham Risk Score stratification (years). (−) indicates 95% CI of screening interval for HbA1c screening test calculated by non-parametric 15,000 times bootstrapping simulations
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Fig3: DM screening intervals for Hba1c screening test by Framingham Risk Score stratification (years). (−) indicates 95% CI of screening interval for HbA1c screening test calculated by non-parametric 15,000 times bootstrapping simulations

Mentions: Figure 3 shows the time at which the signal exceeded noise, stratified by Framingham Risk Score and age. For all age groups, DM screening intervals decreased as Framingham Risk Score increased. Similar to BMI stratification, the highest Framingham risk group in those 30–44 years old demonstrated a much shorter interval than those in other age groups. These results were consistent even after analyzing data in each cohort independently (Appendix 1, 2, 3 and 4). We found that informative intervals were, predictably, shorter in the high DM risk group compared to low risk group (Appendix 6) [28].Fig. 3


Diabetes screening intervals based on risk stratification
DM screening intervals for Hba1c screening test by Framingham Risk Score stratification (years). (−) indicates 95% CI of screening interval for HbA1c screening test calculated by non-parametric 15,000 times bootstrapping simulations
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120442&req=5

Fig3: DM screening intervals for Hba1c screening test by Framingham Risk Score stratification (years). (−) indicates 95% CI of screening interval for HbA1c screening test calculated by non-parametric 15,000 times bootstrapping simulations
Mentions: Figure 3 shows the time at which the signal exceeded noise, stratified by Framingham Risk Score and age. For all age groups, DM screening intervals decreased as Framingham Risk Score increased. Similar to BMI stratification, the highest Framingham risk group in those 30–44 years old demonstrated a much shorter interval than those in other age groups. These results were consistent even after analyzing data in each cohort independently (Appendix 1, 2, 3 and 4). We found that informative intervals were, predictably, shorter in the high DM risk group compared to low risk group (Appendix 6) [28].Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes.

Methods: This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals based on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We adapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a linear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1.

Results: Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48 (30–74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30–44 years old, HbA1c screening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMI > 30) years, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ≥20%) years. This trend was consistent in other age and risk groups as well; among obese 30–44 year olds, we found substantially shorter intervals compared to other groups.

Conclusion: HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk stratification should be applied when deciding an optimal HbA1c screening interval in the general population to minimize overdiagnosis and overtreatment.

No MeSH data available.