title: Assessment of response rates and yields for Two opportunistic Tools for Early detection of Non-diabetic hyperglycaemia and Diabetes (ATTEND). A randomised controlled trial and cost-effectiveness analysis.
abstract: OBJECTIVE
  To assess the opportunistic use in primary care of a computer risk score versus a self-assessment risk score for undiagnosed type 2 diabetes.
  
  
  METHODS
  We conducted a randomised controlled trial in 11 primary care practices in the UK. 577 patients aged 40-75years with no current diagnosis of type 2 diabetes were recruited to a computer based risk score (Leicester Practice Computer Risk Score (LPCRS)) or a patient self-assessment score (Leicester Self-Assessment Score (LSAS)).
  
  
  RESULTS
  The rate of self-referral blood tests was significantly higher for the LPCRS compared to the LSAS, 118.98 (95% CI: 102.85, 137.64) per 1000 high-risk patient years of follow-up compared to 92.14 (95% CI: 78.25, 108.49), p=0.022. Combined rate of diagnosis of type 2 diabetes and those at risk of developing the disease (i.e. impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)) was similar between the two arms, 15.12 (95% CI: 9.11, 25.08) per 1000 high-risk patient years for LPCRS compared to 14.72 (95% CI: 9.59, 22.57) for the LSAS, p=0.699. For the base case scenario the cost per new case of type 2 diabetes diagnosed was lower for the LPCRS compared to the LSAS, £168 (95% Credible Interval (CrI): 76, 364), and £352 (95% CrI: 109, 1148), respectively.
  
  
  CONCLUSIONS
  Compared to a self-assessment risk score, a computer based risk score resulted in greater attendance to an initial blood test and is potentially more cost-effective.
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK. Electronic address: kk22@le.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Gillies
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: H
authors.initials: H
authors.lastname: Dallosso
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Brady
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Gray
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: G
authors.initials: G
authors.lastname: Kilgallen
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Willis
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Zafar
authors.affiliation: Leicester Diabetes Centre, University of Leicester, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000191:economics; D042241:Early Diagnosis; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000191:economics; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
keywords: Early detection; Risk scores; Type 2 diabetes