Glucose challenge test screening for prediabetes and early diabetes

• Type of Material: Article
• Authors: S.L. Jackson, Emory University; Sandra E Safo, Emory University; Lisa R Staimez, Emory University; Darin Olson, Emory University; K.M. Venkat Narayan, Emory University; Qi Long, Emory University; Joseph Lipscomb, Emory University; Mary Rhee, Emory University; Peter W Wilson, Emory University; Anne Tomolo, Emory University; Lawrence S Phillips, Emory University
• Language: English
• Date: 2017-05-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Diabetes UK
• Final Published Version (URL): http://dx.doi.org/10.1111/dme.13270
• Title of Journal or Parent Work: Diabetic Medicine
• ISSN: 0742-3071
• Volume: 34
• Issue: 5
• Start Page: 716
• End Page: 724
• Grant/Funding Information: This work was supported in part by US Food and Drug Administration award RO1FD003527 (L.S.P), VA awards HSR&D IIR 07-138 (L.S.P, S.L.J.) and I01-CX001025 (L.S.P.), NIH awards R21DK099716 (L.S.P., Q.L., S.L.J. and L.R.S.), DK066204 (L.S.P.), U01 DK091958 (L.S.P. and M.K.R.), U01 DK098246 (L.S.P. and D.E.O.), K12HD085850 (S.E.S.)., PCORI award ME-1303-5840 (S.E.S. and Q.L.), and a Cystic Fibrosis Foundation award PHILLI12A0 (L.S.P).; Drs Phillips, Olson, Rhee and Tomolo are supported in part by the VA, and Dr. Jackson conducted analyses using VA resources and data.; It was also supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.
• Keywords: Science & Technology; Life Sciences & Biomedicine; HEMOGLOBIN; Endocrinology & Metabolism; TOLERANCE; CLINICAL-DIAGNOSIS; CARDIOVASCULAR-DISEASE; RISK
• Research Categories: Biology, Biostatistics; Health Sciences, Nutrition; Health Sciences, Public Health

Abstract

Aims: 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. 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: oral glucose challenge test; random glucose; and HbA1c level, using an oral glucose tolerance test as the ‘gold standard’. Results: The study population comprised 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 the cohort. 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 HbA1c performed 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 Affairs perspective, and $55 from a US Medicare perspective. Conclusions: 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.