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Yield of opportunistic targeted screening for type 2 diabetes in primary care: the diabscreen study.

Abstract：

PURPOSE:In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors. METHODS:In 11 family practices (total practice population = 49,229) in The Netherlands, we conducted a stepwise opportunistic screening program among patients aged 45 to 75 years by (1) identifying high-risk individuals (=1 diabetes risk factor) and low-risk individuals using the electronic medical record, (2) obtaining a capillary fasting plasma glucose measurement, repeated on a separate day if the value was greater than 110 mg/dL, and (3) obtaining a venous sample if both capillary fasting plasma glucose values were greater than 110 mg/dL and at least 1 sample was 126 mg/dL or greater. We calculated the yield (percentage of invited patients with undiagnosed diabetes), number needed to screen (NNS), and diagnostic value of the risk factors (odds ratio and area under the receiver operating characteristic curve). RESULTS:We invited for a first capillary measurement 3,724 high-risk patients seen during usual care and a random sample of 465 low-risk patients contacted by mail. The response rate was 90% and 86%, respectively. Ultimately, 101 high-risk patients (2.7%; 95% confidence interval [CI], 2.2%-3.3%; NNS = 37) and 2 low-risk patients (0.4%; 95% CI, 0.1%-1.6%; NNS = 233) had undiagnosed diabetes (P <.01). The prevalence of diabetes among patients 45 to 75 years old increased from 6.1% to 6.8% as a result. Among diagnostic models containing various risk factors, a model containing obesity alone was the best predictor of undiagnosed diabetes (odds ratio = 3.2; 95% CI, 2.0-5.2; area under the curve=0.63). CONCLUSIONS:The yield of opportunistic targeted screening was fair; obesity alone was the best predictor of undiagnosed diabetes. Opportunistic screening for type 2 diabetes in primary care could target middle-aged and older adults with obesity.

journal_name

Ann Fam Med

journal_title

Annals of family medicine

authors

Klein Woolthuis EP,de Grauw WJ,van Gerwen WH,van den Hoogen HJ,van de Lisdonk EH,Metsemakers JF,van Weel C

doi

10.1370/afm.997

subject

Has Abstract

pub_date

2009-09-01 00:00:00

pages

422-30

issue

eissn

1544-1709

issn

1544-1717

pii

7/5/422

journal_volume

pub_type

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Yield of opportunistic targeted screening for type 2 diabetes in primary care: the diabscreen study.