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Screening for type 2 diabetes in a high-risk population: study design and feasibility of a population-based randomized controlled trial

By Klijs Bart, Otto Suzie J, Heine Robert J, van der Graaf Yolanda, Lous Jan J and de Koning Harry J


<p>Abstract</p> <p>Background</p> <p>We describe the design and present the results of the first year of a population-based study of screening for type 2 diabetes in individuals at high risk of developing the disease. High risk is defined as having abdominal obesity.</p> <p>Methods</p> <p>Between 2006 and 2007, 79,142 inhabitants of two Dutch municipalities aged 40–74 years were approached to participate in screening. Eligible participants had a self-reported waist circumference of ≥80 cm for women and ≥94 cm for men, and no known pre-existing diabetes. Of the respondents (n = 20,578; response rate 26%), 16,135 were abdominally obese. In total, 10,609 individuals gave written informed consent for participation and were randomized into either the screening (n = 5305) or the control arm (n = 5304). Participants in the screening arm were invited to have their fasting plasma glucose (FPG) measured and were referred to their general practitioner (GP) if it was ≥6.1 mmol/L. In addition, blood lipids were determined in the screening arm, because abdominal obesity is often associated with cardiovascular risk factors. Participants in both arms received written healthy lifestyle information. Between-group differences were analyzed with Chi-square tests and logistic regression (categorical variables) and unpaired t-tests (continuous variables).</p> <p>Results</p> <p>The screening attendance rate was 84.1%. Attending screening was associated with age at randomization (OR = 1.03, 95% CI 1.02-1.04), being married (OR = 1.57, 95% CI 1.33-1.83) and not-smoking currently (OR = 0.52, 95% CI 0.44-0.62). Of the individuals screened, 5.6% had hyperglycemia, and a further 11.6% had an estimated absolute cardiovascular disease risk of 5% or higher, according to the Systematic Coronary Risk Evaluation risk model. These participants were referred to their GP.</p> <p>Conclusions</p> <p>Self-reported home-assessed waist circumference could feasibly detect persons at high risk of hyperglycemia or cardiovascular disease. Continuation of the large-scale RCT is warranted to test the hypothesis that targeted population-based screening for type 2 diabetes leads to a significant reduction in cardiovascular morbidity and mortality.</p> <p>Trial registration</p> <p>ISRCTN75983009</p

Topics: Early detection, Screening, Type 2 diabetes, Abdominal obesity, Waist circumference, Public aspects of medicine, RA1-1270, Medicine, R, DOAJ:Public Health, DOAJ:Health Sciences
Publisher: BioMed Central
Year: 2012
DOI identifier: 10.1186/1471-2458-12-671
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