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

• 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
• Journal Title: Diabetes Care
• Volume: Volume 36, Number 7
• Publisher: American Diabetes Association | 2013-07-01, Pages 1981-1987
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2337/dc12-1752
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; IMPAIRED FASTING GLUCOSE; LIFE-STYLE INTERVENTION; ECONOMIC COSTS; ADULTS; CARE; US; PREVENTION; MELLITUS; DISEASE

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.