Glucose challenge test screening for prediabetes and undiagnosed diabetes.
OBJECTIVE
Diabetes prevention and care are limited by lack of screening. We hypothesised that screening could be done with a strategy similar to that used near-universally for gestational diabetes, i.e. a 50 g oral glucose challenge test (GCT) performed at any time of day, regardless of meal status, with one 1 h sample.


METHODS
At a first visit, participants had random plasma and capillary glucose measured, followed by the GCT with plasma and capillary glucose (GCTplasma and GCTcap, respectively). At a second visit, participants had HbA(1c) measured and a diagnostic 75 g OGTT.


RESULTS
The 1,573 participants had mean age of 48 years, BMI 30.3 kg/m(2) and 58% were women and 58% were black. Diabetes (defined by WHO) was present in 4.6% and prediabetes (defined as impaired glucose tolerance [2 h glucose 7.8-11.1 (140-199 mg/dl) with fasting glucose <or=6.9 (125 mg/dl)] and/or impaired fasting glucose with plasma glucose 6.1-6.9 mmol/l [110-125 mg/dl]) in 18.7%. The GCTplasma provided areas under the receiver-operating-characteristic curves of 0.90, 0.82 and 0.79 for detection of diabetes, diabetes or prediabetes, and prediabetes, respectively, all of which were higher than GCTcap, random and capillary glucose, and HbA(1c) (p < 0.02 for all). The performance of GCTplasma was unaffected by time after meals or time of day, and was better in blacks than whites, but otherwise comparable in men and women, and in groups with differing prevalence of glucose intolerance. GCTplasma screening would cost approximately US$84 to identify one person with previously unrecognised diabetes or prediabetes.


CONCLUSIONS
GCT screening for prediabetes and previously unrecognised diabetes would be accurate, convenient and inexpensive. Widespread use of GCT screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications.
Phillips
L S
LS
Division of Endocrinology and Metabolism, Emory University School of Medicine, 101 Woodruff Circle, WMRB Room 1027, Atlanta, GA 30322, USA. medlsp@emory.edu
Ziemer
D C
DC
Kolm
P
P
Weintraub
W S
WS
Vaccarino
V
V
Rhee
M K
MK
Chatterjee
R
R
Narayan
K M V
KM
Koch
D D
DD
D000293:Adolescent; D000328:Adult; D044383:Black People; D001786:Blood Glucose / Q000032:analysis*; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005845:Georgia; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D044465:White People; D055815:Young Adult; D001741:Black or African American
D001786:Blood Glucose; D006442:Glycated Hemoglobin