| Effectiveness/Harms of Screening Tests | |
- Know that a 2-hour PG value of 200 mg/dL (11.1 mmol/L) after a 75-g OGTT is considered the gold standard for diagnosing diabetes mellitus.
 - Recognize that the ADA criterion for diabetes of an FBG of 126 mg/dL (7.0 mmol/L) is more reproducible than the 2-hour PG and has excellent specificity for diagnosing diabetes, but its sensitivity is only approximately 50%.
- Know that lowering the threshold FBG value increases the sensitivity but decreases the specificity for a diagnosis of diabetes; therefore, although the optimal threshold FBG value to exclude diabetes may be <100 mg/dL (5.6 mmol/L), a 2-hour PG would be required to confirm diabetes in patients with an FBG 100 mg/dL (5.6 mmol/L).
- Recognize that the HbA1ctest has good specificity but only moderate sensitivity for detecting undiagnosed diabetes, and its performance varies depending on the population and cutpoint used.
- 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.
- Know that risk assessment questionnaires developed to screen for diabetes have inadequate sensitivity and specificity in identifying persons with undiagnosed diabetes.
- Know that there is limited evidence regarding the harms of screening for diabetes; however, screening tests appear to be safe and have minimal effect on quality of life.
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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.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. |
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Screening for Type 2 Diabetes
