title: Screening for diabetes and prediabetes should be cost-saving in patients at high risk.
abstract: OBJECTIVE
  Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk.
  
  
  METHODS
  Five screening tests were performed in 1,573 adults without known diabetes--random plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1C--and a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes.
  
  
  RESULTS
  Compared with no screening, cost-savings would be obtained largely from screening those at higher risk, including those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, with differences of up to -46% of health system costs for screening for diabetes and -21% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test for most high-risk groups for this population over the course of 3 years.
  
  
  CONCLUSIONS
  From a health economics perspective, screening for diabetes and high-risk prediabetes should target patients at higher risk, particularly those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, for whom screening can be most cost-saving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.
authors: Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA. ranee.chatterjee@duke.edu
authors: Ranee
authors: R
authors: Chatterjee
authors: K M Venkat
authors: KM
authors: Narayan
authors: Joseph
authors: J
authors: Lipscomb
authors: Sandra L
authors: SL
authors: Jackson
authors: Qi
authors: Q
authors: Long
authors: Ming
authors: M
authors: Zhu
authors: Lawrence S
authors: LS
authors: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*
chemical_list: D001786:Blood Glucose
references: BMJ. 2000 Apr 29;320(7243):1197-200
references: 10784550
references: Diabetes Care. 2009 Feb;32(2):287-94
references: 19017771
references: Ann Intern Med. 2004 May 4;140(9):689-99
references: 15126252
references: Diabetologia. 2009 Sep;52(9):1798-807
references: 19557386
references: Popul Health Manag. 2009 Apr;12(2):95-101
references: 19361252
references: Diabetes Care. 2005 Sep;28(9):2223-9
references: 16123494
references: Arch Intern Med. 2010 Sep 13;170(16):1470-9
references: 20837834
references: Diabetes Care. 2008 Dec;31(12):2307-11
references: 19033416
references: Popul Health Manag. 2009 Jun;12(3):157-63
references: 19534580
references: N Engl J Med. 2002 Feb 7;346(6):393-403
references: 11832527
references: Diabetes Care. 2010 Jan;33 Suppl 1:S11-61
references: 20042772
references: Diabetes Care. 2005 Nov;28(11):2626-32
references: 16249530
references: Ann Intern Med. 2005 May 17;142(10):813-20
references: 15897531
references: Lancet. 2010 Apr 17;375(9723):1365-74
references: 20356621
references: Diabetes Care. 2008 Mar;31(3):596-615
references: 18308683
references: Prev Chronic Dis. 2010 Sep;7(5):A109
references: 20712936
references: Diabetes Care. 2003 Sep;26(9):2518-23
references: 12941712
references: Diabetes Care. 2010 Jul;33(7):1484-90
references: 20587721
references: Diabetes Care. 2003 Jan;26(1):36-47
references: 12502656
references: Med Care. 2008 Mar;46(3):287-92
references: 18388843
references: Int J Technol Assess Health Care. 2009 Jul;25(3):350-8
references: 19619354
references: Diabetes Care. 2010 Aug;33(8):1872-94
references: 20668156
references: Diabetes Care. 2007 Nov;30(11):2874-9
references: 17698614
references: Diabetes Care. 2001 Jun;24(6):1038-43
references: 11375367
references: Health Technol Assess. 2007 May;11(17):iii-iv, ix-xi, 1-125
references: 17462167
references: BMJ. 2008 May 24;336(7654):1180-5
references: 18426840