Abstract
To identify optimal cut-off points of fasting plasma glucose for two-step strategy in screening of undiagnosed diabetes in Chinese people, data were selected from two cross-sectional studies of Metabolic Syndrome in Zhejiang Province of China, Zhejiang Statistical Yearbook (2010), and published literatures. Two-step strategy was used among 17437 subjects sampled from population to screen undiagnosed diabetes. Effectiveness (proportion of cases identified), costs (including medical and non-medical costs), and efficiency (cost per case identified) of these different two-step screening strategies were evaluated. This study found the sensitivities of all the two-step screening strategies with further Oral Glucose Tolerance Test (OGTT) at different Fasting Plasma Glucose (FPG) cut-off points from 5.0 to 7.0 (mmol/L) ranged from 0.66 to 0.91. For the FPG point of 5.0 mmol/L, 91 percent of undiagnosed cases were identified. The total cost of detecting one undiagnosed diabetes case ranged from 547.1 to 1294.5 CNY/case, and the strategy with FPG at cut-off point of 6.1 (mmol/L) resulted in the least cost. Considering both sensitivity and cost of screening diabetes, FPG cut-off point at 5.4 mmol/L was optimized for the two-step strategy. In conclusion, different optimal cut-off points of FPG for two-step strategy in screening of undiagnosed diabetes should be used for different screening purposes.
Highlights
Type 2 diabetes is a serious and costly disease and a growing public health problem worldwide including China, and its control and prevention has become one of major health priorities [1,2]
A previous of diabetes diagnosis was reported by 905 subjects of them, and 622 potential diabetes cases were identified by Fasting Plasma Glucose (FPG) test and Oral Glucose Tolerance Test (OGTT)
Guidelines for diabetes screening are mostly based on clinical studies and expert recommendation, so population-based study was proposed for more strong evidence
Summary
Type 2 diabetes is a serious and costly disease and a growing public health problem worldwide including China, and its control and prevention has become one of major health priorities [1,2]. Previous studies indicated that the progression of diabetes could be delayed or prevented substantially by lifestyle modification or medications [3,4,5]. Diabetes screening is an effective preventative method for catching the development of diabetes at an early stage. The increased likelihood that those with diagnosed diabetes will seek further medical advice and receive adequate treatment increases the importance of diabetes screening [6]. FPG test is problematic as the sole screening test due to its low sensitivity, while OGTT is sufficient to diagnose diabetes mellitus. It is extremely necessary to combine the methods of FPG test and OGTT in diabetes screening or epidemiological survey.
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