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Recommendation
| Recognize that consideration of age, BMI, and race/ethnicity in screening to detect diabetes and pre-diabetes may be less important than evaluation of random plasma glucose.
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Evidence:
- One study of 1471 U.S. adults found that a random CBG level of
 121 mg/dL (6.7 mmol/L) was 78% sensitive and 86% specific for a diagnosis of diabetes (based on a 2-hour PG of 200 mg/dL [11.1 mmol/L]) (66).
- In SIGT-5, among 1129 individuals without diabetes the AROC for random plasma glucose alone as a screen for diabetes (0.81) and dysglycemia (0.72) were highly significant (P<0.001) and significantly higher than both the age >45 years plus BMI >25 kg/m2 cutoffs (both 0.63) and the age plus BMI plus black race cutoffs (0.63 and 0.58), P<0.0001 (67).
- In SIGT-2, another cross-sectional study of 990 adults without diabetes, the AROC was 0.80 (CI, 0.74 to 0.86) for random plasma glucose to identify diabetes and 0.72 (CI, 0.68 to 0.75) to identify any glucose intolerance, both highly significant (P<0.001) (68).
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Comments:
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| Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
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PIER is copyrighted (c) 2009 by the American College of Physicians,
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Screening for Type 2 Diabetes
> Effectiveness/Harms of Screening Tests
