Screening for Diabetes and Prediabetes Should Be Cost-Saving in Patients at High Risk

• Type of Material: Article
• Authors: Ranee Chatterjee, Duke University; K.M. Venkat Narayan, Emory University; Joseph Lipscomb, Emory University; Sandra L. Jackson, Emory University; Qi Long, Emory University; Ming Zhu, affiliation; Lawrence S Phillips, Emory University
• Language: English
• Date: 2013-07-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2013 by the American Diabetes Association.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2337/dc12-1752
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 36
• Issue: 7
• Start Page: 1981
• End Page: 1987
• Grant/Funding Information: This work was supported in part by National Institutes of Health awards DK0-66204 (L.S.P.) and UL1-RR0-25008, VA award HSR&D IIR 07-138 (L.S.P., K.M.V.N., S.L.J.), and Cystic Fibrosis Foundation award PHILLI12A0 (L.S.P.).
• Keywords: CARE; ADULTS; LIFE-STYLE INTERVENTION; Science & Technology; IMPAIRED FASTING GLUCOSE; MELLITUS; Endocrinology & Metabolism; PREVENTION; Life Sciences & Biomedicine; US; ECONOMIC COSTS; DISEASE
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Objective-Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compar ed the economics of screening according to baseline risk. Research design and methods-Five screening tests were performed in 1,573 adults without known diabetesdrandom plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap] ), and A1Cdand a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes. ResultsCompared with no screening, cost-savings would be obtained largely fromscreening those at higher risk, including those with BMI .35 kg/m2, systolic blood pressure $130 mmHg, or age.55 years, with differences of up to246%of health systemcosts for screening for diabetes and 221% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test formost high-risk groups for this population over the course of 3 years. Conclusions-From a health economics perspective, screening for diabetes and highrisk prediabetes should target patients at higher risk, particularly those with BMI .35 kg/m2, systolic blood pressure $130 mmHg, or age .55 years, for whom screening can be most costsaving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.