title: Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test?
abstract: BACKGROUND
  The standard method of identifying persons at high risk for type 2 diabetes mellitus involves detection of impaired glucose tolerance, which requires a costly and inconvenient 2-hour oral glucose tolerance test. Because clinical trials have indicated that diabetes is preventable by using behavioral or pharmacologic interventions, less expensive methods of identifying high-risk persons are needed.
  
  
  OBJECTIVE
  To determine whether multivariable models are superior to glucose tolerance tests for identifying persons at high risk for diabetes mellitus.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  San Antonio, Texas.
  
  
  METHODS
  1791 Mexican Americans and 1112 non-Hispanic whites without diabetes at baseline who were randomly selected from census tracts.
  
  
  METHODS
  Medical history; body mass index; blood pressure; fasting and 2-hour plasma glucose levels; fasting serum total, low-density lipoprotein, and high-density lipoprotein cholesterol levels; and triglyceride level.
  
  
  RESULTS
  For prediction of 7.5-year incidence of type 2 diabetes, the area under the receiver-operating characteristic (ROC) curve for a multivariable model involving readily available clinical variables was significantly (P < 0.001) greater than the area under the ROC curve for the 2-hour glucose value alone (84.3% vs. 77.5%). Impaired glucose tolerance represents a single point on the latter curve. Adding the 2-hour glucose measurement to the multivariable model increased the area under its ROC curve, but only from 84.3% to 85.7%.
  
  
  CONCLUSIONS
  Persons at high risk for diabetes mellitus are better identified by using a simple prediction model than by relying exclusively on the results of a 2-hour oral glucose tolerance test. Although adding the 2-hour glucose variable to the model enhanced prediction, the resulting slight improvement entails greater cost and inconvenience.
authors.affiliation: Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. stern@uthscsa.edu
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stern
authors.forename: Ken
authors.initials: K
authors.lastname: Williams
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors; D013781:Texas / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D008055:Lipids