Performance of an A1C and Fasting Capillary Blood Glucose Test for Screening Newly Diagnosed Diabetes and Pre-Diabetes Defined by an Oral Glucose Tolerance Test in Qingdao, China

OBJECTIVE - The study's goal was to evaluate the performance of A] C and lasting capillary blood glucose (FCG) tests as mass screening tools for diabetes and pre-diabetes, as determined by the standard oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS - Data from 2,332 individuals aged 35-74 years who participated in a population-based cross-sectional diabetes survey in Qingdao, China, were analyzed. A 2-h 75-g OGTT was used to diagnose diabetes. The performance of A1C and FCG was evaluated against the results of the OGTTs by using receiver operating characteristic curve (ROC) analysis. RESULTS - The prevalence of newly diagnosed diabetes and pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) was 11.9 and 29.5%, respectively. For subjects with newly diagnosed diabetes, the area under the ROC curve was 0.67 for A1C and 0.77 for FCG (P < 0.01) in men and 0.67 and 0.75 (P < 0.01) in women, whereas for pre-diabetes, these values were 0.47 and 0.64 (P < 0.001) in men and 0.51 and 0.65 (P < 0.001.) in women. At the optimal A1C cutoff point of >= 5.6% for newly diagnosed diabetes, sensitivities (specificities) were 64.4% (61.6%) for men and 62.3% (63.3%) for women. CONCLUSIONS - As a screening tool for newly diagnosed diabetes and pre-diabetes, the FCG measurement performed better than A I C in this general Chinese population.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000275562700018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701Endocrinology & MetabolismSCI(E)57ARTICLE3545-5503

Análise econômica de programa para rastreamento do diabetes mellitus no Brasil Economic analysis of a screening program for diabetes mellitus in Brazil

OBJETIVO: Diabetes mellitus é um problema de saúde pública com elevado ônus social e econômico, cujo diagnóstico é desconhecido em metade dos indivíduos portadores. Em 2001, o Ministério da Saúde realizou a Campanha Nacional para a Detecção do Diabetes Mellitus. Assim, o objetivo do estudo foi estimar o impacto econômico e o rendimento desse rastreamento populacional. MÉTODOS: Baseado no número de rastreados com resultados positivos (glicemia capilar em jejum >100 mg/dl ou fora do jejum >140 mg/dl), foram estimados os prováveis casos novos de diabetes mellitus e construído modelo de decisão analítico. Dados primários e secundários foram utilizados para estimar os custos (em Reais) e o rendimento (casos novos de diabetes mellitus detectados) do rastreamento com o pressuposto de pagador único. Análises de sensibilidade foram conduzidas para avaliar o efeito de alguns parâmetros nessas estimativas. RESULTADOS: Considerando-se a prevalência de diabetes mellitus não diagnosticado na população-alvo de 4,8%, o número provável de novos casos de diabetes mellitus diagnosticados foi de 518.579. Isso, pressupondo que um terço dos participantes com teste positivo procurou a confirmação (23 casos por 1.000 rastreados). O custo por novo caso de diabetes mellitus diagnosticado a partir desses pressupostos seria de R$89. Em análises de sensibilidade, os resultados foram sensíveis ao percentual dos testes confirmatórios. CONCLUSÕES: Apesar dos expressivos custos com a campanha de rastreamento no Brasil, o rendimento foi comparável a outras ações preventivas e, em termos absolutos, o custo por novo caso de diabetes mellitus detectado foi inferior ao relatado por outros países.<br>OBJECTIVE: Diabetes mellitus is a common disease and costly public health concern and an expressive number of affected individuals have undiagnosed diabetes mellitus. In 2001, the Brazilian Ministry of Health conducted a national diabetes screening campaign. The purpose of this study was to estimate the yield and economic impact of this screening strategy. METHODS: Based on positive screenees (fasting glucose >100 mg/dL or nonfasting >140 mg/dL) probable new cases of diabetes were estimated and a decision analytic model was built up. Primary and secondary data were used to estimate screening cost (in Brazilian Reais, R$) and yield (new cases of diabetes detected), assuming a single-payer-perspective. Sensitivity analyses were performed. RESULTS: Assuming a prevalence of undiagnosed diabetes mellitus of 4.8%, probable new cases of diabetes were 518,579 (23 new cases per 1,000 subjects screened), considering that 33% of positive-screening individuals underwent confirmatory glucose testing. The cost per new case of diabetes diagnosed would be R$89. The results were sensitive to percentage of confirmatory tests performed. CONCLUSIONS: The costs of nationwide community screening in Brazil were significant, however, in absolute terms lower than those described by other countries