Diabetes screening intervals based on risk stratification.

Sachiko Ohde,Gautam A Deshpande,Tsuguya Fukui,Rafael Perera,Hiroshi Yokomichi,Osamu Takahashi,Emily Mcfadden,Zentaro Yamagata

doi:10.1186/s12902-016-0139-1

Abstract

BackgroundGuidelines 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.MethodsThis 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.ResultsAmong 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.ConclusionHbA1c 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.

Highlights

Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion
In the United States, the American Diabetes Association recommends that screening for Type 2 DM in adults occur roughly every 3 years, though this is level IV evidence [2,3,4]
In the UK, NICE guidelines recommend that general practitioners first utilize risk assessment tools such as the Cambridge diabetes risk score [5] or Leicester practice score [6] before measuring HbA1c, measuring HbA1c only if patients are found to be at high risk with subsequent re

Summary

Introduction

Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. That clinicians provide overly frequent screening, often annually, for a large number of apparently healthy patients [9], despite existing data suggesting that this is not necessary [7, 10]. This may be especially problematic given that previous analyses of the characteristics of the HbA1c assay have demonstrated that the test possesses significant short-term variability, and that toofrequent testing may lead to diagnostic confusion [11]

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