title: Glucose challenge test screening for prediabetes and early diabetes.
abstract: To test the hypothesis that a 50-g oral glucose challenge test with 1-h glucose measurement would have superior performance compared with other opportunistic screening methods.
  
  
  
  In this prospective study in a Veterans Health Administration primary care clinic, the following test performances, measured by area under receiver-operating characteristic curves, were compared: 50-g oral glucose challenge test; random glucose; and HbA1clevel, using a 75-g oral glucose tolerance test as the 'gold standard'.
  
  
  
  The study population was comprised of 1535 people (mean age 56 years, BMI 30.3 kg/m2, 94% men, 74% black). By oral glucose tolerance test criteria, diabetes was present in 10% and high-risk prediabetes was present in 22% of participants. The plasma glucose challenge test provided area under receiver-operating characteristic curves of 0.85 (95% CI 0.78-0.91) to detect diabetes and 0.76 (95% CI 0.72-0.80) to detect high-risk dysglycaemia (diabetes or high-risk prediabetes), while area under receiver-operating characteristic curves for the capillary glucose challenge test were 0.82 (95% CI 0.75-0.89) and 0.73 (95% CI 0.69-0.77) for diabetes and high-risk dysglycaemia, respectively. Random glucose performed less well [plasma: 0.76 (95% CI 0.69-0.82) and 0.66 (95% CI 0.62-0.71), respectively; capillary: 0.72 (95% CI 0.65-0.80) and 0.64 (95% CI 0.59-0.68), respectively], and HbA1cperformed even less well [0.67 (95% CI 0.57-0.76) and 0.63 (95% CI 0.58-0.68), respectively]. The cost of identifying one case of high-risk dysglycaemia with a plasma glucose challenge test would be $42 from a Veterans Health Administration perspective, and $55 from a US Medicare perspective.
  
  
  
  Glucose challenge test screening, followed, if abnormal, by an oral glucose tolerance test, would be convenient and more accurate than other opportunistic tests. Use of glucose challenge test screening could improve management by permitting earlier therapy.
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Jackson
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Safo
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Staimez
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Olson
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: K M V
authors.initials: KMV
authors.lastname: Narayan
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Long
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Rhee
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.
authors.forename: P W F
authors.initials: PWF
authors.lastname: Wilson
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Tomolo
authors.affiliation: Atlanta VA Medical Center, Decatur, GA, USA.|Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005947:Glucose / Q000494:pharmacology*; D005951:Glucose Tolerance Test / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve
chemical_list: D001786:Blood Glucose; D005947:Glucose