title: Optimal cut-off points for two-step strategy in screening of undiagnosed diabetes: a population-based study in China.
abstract: To identify optimal cut-off points of fasting plasma glucose for two-step strategy in screening of undiagnosed diabetes in Chinese people, data were selected from two cross-sectional studies of Metabolic Syndrome in Zhejiang Province of China, Zhejiang Statistical Yearbook (2010), and published literatures. Two-step strategy was used among 17437 subjects sampled from population to screen undiagnosed diabetes. Effectiveness (proportion of cases identified), costs (including medical and non-medical costs), and efficiency (cost per case identified) of these different two-step screening strategies were evaluated. This study found the sensitivities of all the two-step screening strategies with further Oral Glucose Tolerance Test (OGTT) at different Fasting Plasma Glucose (FPG) cut-off points from 5.0 to 7.0 (mmol/L) ranged from 0.66 to 0.91. For the FPG point of 5.0 mmol/L, 91 percent of undiagnosed cases were identified. The total cost of detecting one undiagnosed diabetes case ranged from 547.1 to 1294.5 CNY/case, and the strategy with FPG at cut-off point of 6.1 (mmol/L) resulted in the least cost. Considering both sensitivity and cost of screening diabetes, FPG cut-off point at 5.4 mmol/L was optimized for the two-step strategy. In conclusion, different optimal cut-off points of FPG for two-step strategy in screening of undiagnosed diabetes should be used for different screening purposes.
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Cong
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Gangqiang
authors.initials: G
authors.lastname: Ding
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Xinwei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Ruying
authors.initials: R
authors.lastname: Hu
authors.affiliation: Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Le
authors.initials: L
authors.lastname: Fang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Qingfang
authors.initials: Q
authors.lastname: He
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Danting
authors.initials: D
authors.lastname: Su
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Gong
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Mingbin
authors.initials: M
authors.lastname: Liang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged