OBJECTIVE -To assess the Australian protocol for identifying undiagnosed type 2 diabetes and impaired glucose metabolism. RESEARCH DESIGN AND METHODS -TheAustralian screening protocol recommends a stepped approach to detecting undiagnosed type 2 diabetes based on assessment of risk status, measurement of fasting plasma glucose (FPG) in individuals at risk, and further testing according to FPG. The performance of and variations to this protocol were assessed in a population-based sample of 10,508 Australians.RESULTS -The protocol had a sensitivity of 79.9%, specificity of 79.9%, and a positive predictive value (PPV) of 13.7% for detecting undiagnosed type 2 diabetes and sensitivity of 51.9% and specificity of 86.7% for detecting impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). To achieve these diagnostic rates, 20.7% of the Australian adult population would require an oral glucose tolerance test (OGTT). Increasing the FPG cut point to 6.1 mmol/l (110 mg/dl) or using HbA 1c instead of FPG to determine the need for an OGTT in people with risk factors reduced sensitivity, increased specificity and PPV, and reduced the proportion requiring an OGTT. However, each of these protocol variations substantially reduced the detection of IGT or IFG.CONCLUSIONS -The Australian screening protocol identified one new case of diabetes for every 32 people screened, with 4 of 10 people screened requiring FPG measurement and 1 in 5 requiring an OGTT. In addition, 1 in 11 people screened had IGT or IFG. Including HbA 1c measurement substantially reduced both the number requiring an OGTT and the detection of IGT or IFG. Diabetes Care 27:367-371, 2004T ype 2 diabetes is a common and serious condition that is associated with reduced life expectancy and considerable morbidity. It may remain undetected for a number of years, and, consequently, a significant proportion of people with newly diagnosed type 2 diabetes has established complications at the time of diagnosis (1,2).The role of early detection of undiagnosed type 2 diabetes in asymptomatic individuals as a strategy to reduce the personal, public, and economic cost of type 2 diabetes has been extensively reviewed (3). Although there is some circumstantial evidence that earlier detection is associated with improved outcomes (4), definitive evidence of benefit is lacking. Despite this, early detection of type 2 diabetes continues to be recommended by a number of organizations (5,6).In Australia, the National Health and Medical Research Council has recently endorsed a national evidence-based guideline for case detection and diagnosis of type 2 diabetes (7). This guideline was developed through an extensive and systematic review of the literature. It recommends a stepped approach to the diagnosis of people with previously undiagnosed type 2 diabetes based on assessment of an individual's risk status, measurement of fasting plasma glucose (FPG) in individuals at risk, and further testing according to the FPG result (Fig. 1).Since the release of the findings of the Fin...

RESEARCH DESIGN AND METHODS -A randomly selected representative national sample of 1,024 people aged Ͼ15 years was surveyed. Each participant had fasting blood glucose and HbA 1c measured. Subjects with a fasting blood glucose Ͼ5.0 mmol/l (90 mg/dl) and Ͻ11.1 mmol/l (200 mg/dl) or a fasting blood glucose Յ5.0 mmol/l and an HbA 1c Ͼ6.0% and every fifth subject with a fasting blood glucose Յ5.0 mmol/l and a normal HbA 1c had a 75-g oral glucose tolerance test (OGTT). A total of 472 individuals had an OGTT based on these criteria. Subjects with a fasting blood glucose Ն11.1 mmol/l and an elevated HbA 1c were diagnosed as having diabetes.RESULTS -The mean age was 41.3 years, and the mean BMI was 32.3 kg/m 2 . The agestandardized prevalence of diabetes was 15.1% (CI 12.5-17.6), 12.2% (8.7-15.8) in men and 17.6% (14.0 -21.1) in women (NS), of which only 2.1% was previously diagnosed. A total of 75% of people with newly diagnosed diabetes had a fasting plasma glucose Ն7.0 mmol/l (126 mg/dl). The prevalence of impaired glucose tolerance was 9.4% (7.3-11.5) and of impaired fasting glycemia 1.6% (0.7-2.6). Undiagnosed diabetes was significantly associated with increasing age, obesity, hypertension, and a family history of diabetes.CONCLUSIONS -The current prevalence of diabetes in Tonga is 15.1%, of which 80% is undiagnosed. A similar survey in 1973 reported a 7.5% diabetes prevalence, indicating a doubling of diabetes over the past 25 years. In addition, lesser degrees of glucose intolerance are common, and much of the community is overweight Diabetes Care 25: 1378 -1383, 2002

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