Abstract
To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.
Highlights
Pre-diabetes is a relatively high-risk state for diabetes.[1]
We identified screening potential of fasting plasma glucose (FPG), cost per case identified by two-step strategy, and the optimal FPG cut-points for two-step strategy in screening undiagnosed diabetes and/or pre-diabetes in general Chinese population
The prevalences of isolated fasting diabetes and diagnosed diabetes were similar between men and women; the prevalences of isolated 2h post-load diabetes, combined fasting and post-load diabetes, undiagnosed diabetes, and total diabetes were slightly higher in men than those in women, but the differences were not statistically significant except for combined fasting and post-load diabetes (P = 0.0427)
Summary
Pre-diabetes (either impaired fasting glucose [IFG] or impaired glucose tolerance [IGT]) is a relatively high-risk state for diabetes.[1] Pre-diabetes and diabetes carry risk of diabetes complications and cardiovascular disease, especially in people who remain with abnormal glucose metabolism despite intensive intervention.[2,3,4] In 2003, American Diabetes Association revised the lower cut-point of fasting plasma glucose (FPG), which redefined IFG from 6.1 mmol/l to 5.6 mmol/l (ADA criteria).[4] World Health Organization and some other organizations adopted a cut-point of 6.1mmol/l for FPG as the upper limit of normoglycaemia as before (WHO criteria).[5] In China, the prevalences of pre-diabetes using WHO criteria and diabetes reached 15.5% and 9.7% respectively, and 60.7% of the people with diabetes had been undiagnosed.[6] screening for pre-diabetes and undiagnosed diabetes in an early stage should be advocated in China
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