title: Efficient cutoff points for three screening tests for detecting undiagnosed diabetes and pre-diabetes: an economic analysis.
abstract: OBJECTIVE
  Opportunistic screening for undiagnosed type 2 diabetes and pre-diabetes (either impaired glucose tolerance or impaired fasting glucose) is recommended by the American Diabetes Association. The aim of this study was to determine efficient cutoff points for three screening tests for detecting undiagnosed diabetes alone or both undiagnosed diabetes and pre-diabetes.
  
  
  METHODS
  We estimated the number of individuals with undiagnosed diabetes alone or with both undiagnosed diabetes and pre-diabetes that could be detected by using different cutoff points for each screening test as the product of the prevalence of each condition, the sensitivity of the tests at each cutoff point for identifying each condition, and the number of individuals who would be eligible for screening in the U.S. We estimated the total cost of opportunistic screening by multiplying the cost for screening one person by the number of individuals screened.
  
  
  RESULTS
  The most efficient cutoff points for both detecting pre-diabetes and undiagnosed diabetes (100 mg/dl for the fasting plasma glucose test, 5.0% for the HbA(1c) test, and 100 mg/dl for the random capillary blood glucose test) were less than those for detecting undiagnosed diabetes alone (110 mg/dl for the fasting plasma glucose test, 5.7% for the HbA(1c) test, and 120 mg/dl for the random capillary blood glucose test).
  
  
  CONCLUSIONS
  A lower cutoff value should be used when screening for pre-diabetes and undiagnosed diabetes together than when screening for undiagnosed diabetes alone.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Mailstop K-10, 4770 Buford Highway NE, Atlanta, GA 30341, USA. Paz2@cdc.gov
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Valdez
authors.forename: Betsy
authors.initials: B
authors.lastname: Cadwell
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Benjamin
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002196:Capillaries; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000191:economics; D005215:Fasting; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000592:standards*; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis* / Q000191:economics; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D014481:United States
chemical_list: D001786:Blood Glucose