Zhang Ping, Engelgau Michael M, Valdez Rodolfo, Cadwell Betsy, Benjamin Stephanie M, Narayan K M Venkat
Division of Diabetes Translation, Centers for Disease Control and Prevention, Mailstop K-10, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
Diabetes Care. 2005 Jun;28(6):1321-5. doi: 10.2337/diacare.28.6.1321.
Opportunistic screening for undiagnosed type 2 diabetes and pre-diabetes (either impaired glucose tolerance or impaired fasting glucose) is recommended by the American Diabetes Association. The aim of this study was to determine efficient cutoff points for three screening tests for detecting undiagnosed diabetes alone or both undiagnosed diabetes and pre-diabetes.
We estimated the number of individuals with undiagnosed diabetes alone or with both undiagnosed diabetes and pre-diabetes that could be detected by using different cutoff points for each screening test as the product of the prevalence of each condition, the sensitivity of the tests at each cutoff point for identifying each condition, and the number of individuals who would be eligible for screening in the U.S. We estimated the total cost of opportunistic screening by multiplying the cost for screening one person by the number of individuals screened.
The most efficient cutoff points for both detecting pre-diabetes and undiagnosed diabetes (100 mg/dl for the fasting plasma glucose test, 5.0% for the HbA(1c) test, and 100 mg/dl for the random capillary blood glucose test) were less than those for detecting undiagnosed diabetes alone (110 mg/dl for the fasting plasma glucose test, 5.7% for the HbA(1c) test, and 120 mg/dl for the random capillary blood glucose test).
A lower cutoff value should be used when screening for pre-diabetes and undiagnosed diabetes together than when screening for undiagnosed diabetes alone.
美国糖尿病协会建议对未诊断的2型糖尿病和糖尿病前期（糖耐量受损或空腹血糖受损）进行机会性筛查。本研究的目的是确定三种筛查试验单独检测未诊断糖尿病或同时检测未诊断糖尿病和糖尿病前期的有效切点。
我们通过将每种情况的患病率、每种切点下检测每种情况的试验敏感性以及美国符合筛查条件的个体数量相乘，估计了使用每种筛查试验的不同切点可检测出的单独患有未诊断糖尿病或同时患有未诊断糖尿病和糖尿病前期的个体数量。我们通过将筛查一人的成本乘以筛查的个体数量来估计机会性筛查的总成本。
同时检测糖尿病前期和未诊断糖尿病的最有效切点（空腹血糖试验为100mg/dl，糖化血红蛋白（HbA1c）试验为5.0%，随机毛细血管血糖试验为100mg/dl）低于单独检测未诊断糖尿病的切点（空腹血糖试验为110mg/dl，糖化血红蛋白（HbA1c）试验为5.7%，随机毛细血管血糖试验为120mg/dl）。
同时筛查糖尿病前期和未诊断糖尿病时应使用比单独筛查未诊断糖尿病更低的切点值。
