title: Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.
abstract: To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.
authors.affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Chundan
authors.initials: C
authors.lastname: Bao
authors.affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China; Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Dianfeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Lan
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Wenxiu
authors.initials: W
authors.lastname: Cui
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Conglan
authors.initials: C
authors.lastname: Sui
authors.affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Yibaina
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Yashuang
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Chronic Noncommunicable Disease Control and Prevention, Harbin Center for Disease Control and Prevention, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
authors.forename: Hongyuan
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D005215:Fasting; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001786:Blood Glucose