The efficacy and cost of alternative strategies for systematic screening for type 2 diabetes in the U.S. population 45-74 years of age.
OBJECTIVE
To simulate the outcomes of alternative strategies for screening the U.S. population 45-74 years of age for type 2 diabetes.


METHODS
We simulated screening with random plasma glucose (RPG) and cut points of 100, 130, and 160 mg/dl and a multivariate equation including RPG and other variables. Over 15 years, we simulated screening at intervals of 1, 3, and 5 years. All positive screening tests were followed by a diagnostic fasting plasma glucose or an oral glucose tolerance test. Outcomes include the numbers of false-negative, true-positive, and false-positive screening tests and the direct and indirect costs.


RESULTS
At year 15, screening every 3 years with an RPG cut point of 100 mg/dl left 0.2 million false negatives, an RPG of 130 mg/dl or the equation left 1.3 million false negatives, and an RPG of 160 mg/dl left 2.8 million false negatives. Over 15 years, the absolute difference between the most sensitive and most specific screening strategy was 4.5 million true positives and 476 million false-positives. Strategies using RPG cut points of 130 mg/dl or the multivariate equation every 3 years identified 17.3 million true positives; however, the equation identified fewer false-positives. The total cost of the most sensitive screening strategy was $42.7 billion and that of the most specific strategy was $6.9 billion.


CONCLUSIONS
Screening for type 2 diabetes every 3 years with an RPG cut point of 130 mg/dl or the multivariate equation provides good yield and minimizes false-positive screening tests and costs.
Johnson
Susan L
SL
Department of Internal Medicine, Michigan Diabetes Research and Training Center, University of Michigan Health System, 1500 E. Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354, USA.
Tabaei
Bahman P
BP
Herman
William H
WH
D000368:Aged; D001786:Blood Glucose; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D005188:False Negative Reactions; D005189:False Positive Reactions; D005951:Glucose Tolerance Test; D005102:Health Expenditures; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics* / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose