Determining the optimal screening interval for type 2 diabetes mellitus using a risk prediction model.

Bo Hu,Lei Kou,Massimo Pietropaolo,Michael B Rothberg,Nana Kobaivanova,Thomas Barwacz,Andrei Brateanu,Abhishek Deshpande,Sihe Wang,Anita D Misra-Hebert

doi:10.1371/journal.pone.0187695

Bo Hu, Lei Kou + Show 8 more

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https://doi.org/10.1371/journal.pone.0187695

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Journal: PloS one	Publication Date: Nov 14, 2017
Citations: 5	License type: CC BY 4.0

Affiliation: Cleveland Clinic, University Hospitals of Cleveland

Abstract

BackgroundProgression to diabetes mellitus (DM) is variable and the screening time interval not well defined. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited.The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval.MethodsWe included non-diabetic adult patients screened for DM in the Cleveland Clinic Health System if they had at least two measurements of glycated hemoglobin (HbA1c), an initial one less than 6.5% (48 mmol/mol) in 2008, and another between January, 2009 and December, 2013. Cox proportional hazards models were created.The primary outcome was DM defined as HbA1C greater than 6.4% (46 mmol/mol). The optimal rescreening interval was chosen based on the predicted probability of developing DM.ResultsOf 5084 participants, 100 (4.4%) of the 2281 patients with normal HbA1c and 772 (27.5%) of the 2803 patients with prediabetes developed DM within 5 years. Factors associated with developing DM included HbA1c (HR per 0.1 units increase 1.20; 95%CI, 1.13–1.27), family history (HR 1.31; 95%CI, 1.13–1.51), smoking (HR 1.18; 95%CI, 1.03–1.35), triglycerides (HR 1.01; 95%CI, 1.00–1.03), alanine aminotransferase (HR 1.07; 95%CI, 1.03–1.11), body mass index (HR 1.06; 95%CI, 1.01–1.11), age (HR 0.95; 95%CI, 0.91–0.99) and high-density lipoproteins (HR 0.93; 95% CI, 0.90–0.95). Five percent of patients in the highest risk tertile developed DM within 8 months, while it took 35 months for 5% of the middle tertile to develop DM. Only 2.4% percent of the patients in the lowest tertile developed DM within 5 years.ConclusionA risk prediction model employing commonly available data can be used to guide screening intervals. Based on equal intervals for equal risk, patients in the highest risk category could be rescreened after 8 months, while those in the intermediate and lowest risk categories could be rescreened after 3 and 5 years respectively.

Highlights

Diabetes Mellitus (DM) is a chronic disease associated with micro and macro vascular complications and multiple organ damage.[1]
Factors associated with developing DM included HbA1c (HR per 0.1 units increase 1.20; 95%CI, 1.13–1.27), family history (HR 1.31; 95%CI, 1.13–1.51), smoking (HR 1.18; 95%CI, 1.03–1.35), triglycerides (HR 1.01; 95%CI, 1.00–1.03), alanine aminotransferase (HR 1.07; 95%CI, 1.03–1.11), body mass index (HR 1.06; 95%CI, 1.01–1.11), age (HR 0.95; 95%CI, 0.91–0.99) and highdensity lipoproteins (HR 0.93; 95% CI, 0.90–0.95)
Based on equal intervals for equal risk, patients in the highest risk category could be rescreened after 8 months, while those in the intermediate and lowest risk categories could be rescreened after 3 and 5 years respectively

Summary

Introduction

Diabetes Mellitus (DM) is a chronic disease associated with micro and macro vascular complications and multiple organ damage.[1]. While the United States Preventive Services Task Force (USPSTF) recommends glucose screening in overweight or obese adults aged 40 to 70 years,[5] the American Diabetes Association suggests that screening should be done in all adults beginning at age 45 years regardless of weight, or at any age when obesity or at least one DM risk factor is present.[6] Glucose abnormalities can be identified measuring the fasting plasma glucose, glycated hemoglobin (HbA1c), or with the oral glucose tolerance test. HbA1c has several advantages when compared to the other two tests: it measures chronic glycemic levels, does not require fasting or two hour testing, and correlates well with the risk of subsequent diabetic complications. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited. The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval

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Conclusion