Screening for Diabetes Mellitus in Adults: The utility of random capillary blood glucose measurements

Engelgau, Michael M.; Thompson, Theodore; Smith, Philip J.; Herman, William H.; Aubert, Ronald E.; Gunter, Elaine W.; Wetterhall, Scott; Sous, E.S.; Ali, Mohamed A

doi:10.2337/diacare.18.4.463

Cited by 56 publications

(38 citation statements)

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“…Consistent with a previous study (15), we found that optimal CBG cut points may be lower for younger subjects and those with longer (Ն8 h) postprandial times. In contrast with that study, in which the best performance was observed among those with the shortest postprandial times (15), we found that CBG performed somewhat better in individuals with longer postprandial times than in those with postprandial times Ͻ8 h. In our study, we also observed better performance and slightly higher optimal cut points in men than in women.…”

Section: Figure 1-empirical Receiver Operating Characteristic Curvessupporting

confidence: 91%

“…The performance of CBG tests may depend on postprandial time and other factors such as age or sex (7,15,17). Consistent with a previous study (15), we found that optimal CBG cut points may be lower for younger subjects and those with longer (Ն8 h) postprandial times.…”

Section: Figure 1-empirical Receiver Operating Characteristic Curvessupporting

confidence: 90%

“…Previous evaluations of CBG screening tests have reported sensitivities of 50 -70% at 90% specificity (15,16). In our study, CBG was Ͼ70% sensitive for the WHO diabetes criterion (13) at 90% specificity.…”

Section: Figure 1-empirical Receiver Operating Characteristic Curvessupporting

confidence: 56%

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Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

et al. 2001

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OBJECTIVE -To evaluate the performance, in settings typical of opportunistic and community screening programs, of screening tests currently recommended by the American Diabetes Association (ADA) for detecting undiagnosed diabetes.RESEARCH DESIGN AND METHODS -Volunteers aged Ն20 years without previously diagnosed diabetes (n ϭ 1,471) completed a brief questionnaire and underwent recording of postprandial time and measurement of capillary blood glucose (CBG) with a portable sensor. Participants subsequently underwent a 75-g oral glucose tolerance test; fasting serum glucose (FSG) and 2-h postload serum glucose (2-h SG) concentrations were measured. The screening tests we studied included the ADA risk assessment questionnaire, the recommended CBG cut point of 140 mg/dl, and an alternative CBG cut point of 120 mg/dl. Each screening test was evaluated against several diagnostic criteria for diabetes (FSG Ն126 mg/dl, 2-h SG Ն200 mg/dl, or either) and dysglycemia (FSG Ն110 mg/dl, 2-h SG Ն140 mg/dl, or either).RESULTS -Among all participants, 10.7% had undiagnosed diabetes (FSG Ն126 or 2-h SG Ն200 mg/dl), 52.1% had a positive result on the questionnaire, 9.5% had CBG Ն140 mg/dl, and 18.4% had CBG Ն120 mg/dl. The questionnaire was 72-78% sensitive and 50 -51% specific for the three diabetes diagnostic criteria; CBG Ն140 mg/dl was 56 -65% sensitive and 95-96% specific, and CBG Ն120 mg/dl was 75-84% sensitive and 86 -90% specific. CBG Ն120 mg/dl was 44 -62% sensitive and 89 -90% specific for dysglycemia. CONCLUSIONS -Low specificity may limit the usefulness of the ADA questionnaire. Lowering the cut point for a casual CBG test (e.g., to 120 mg/dl) may improve sensitivity and still provide adequate specificity.

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Section: Figure 1-empirical Receiver Operating Characteristic Curvessupporting

confidence: 91%

Section: Figure 1-empirical Receiver Operating Characteristic Curvessupporting

confidence: 90%

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Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

et al. 2001

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“…Engelgau et al 34 reported that the performance of random capillary glucose to identify diabetes was better shortly after meals, a finding not reproduced in the present study. However, as the difference between RPG in diabetes vs. NGT tended to be larger in the first few hours after meals (Fig.…”

Section: Discussioncontrasting

confidence: 54%

Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2

et al. 2008

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“…This would agree with the work of others who looked at this previously, albeit with a view to predict diabetes diagnosed by glucose testing. 22,23 In this study we have confirmed that there is a weak association between HbA1c and Hb. This has been a subject of discussion in the debate over the validity of HbA1c measurement in the diagnosis of diabetes, particularly as it is known that various anaemias can affect the HbA1c result.…”

Section: -Specificitysupporting

confidence: 73%

The use of glucose measurements to improve screening for diabetes in clinical practice

et al. 2016

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Introduction: It is estimated that 4 million people will be living with diabetes in England by 2025. It is imperative that we can accurately identify people at risk of diabetes and target interventions to prevent its development. Aim: To determine whether the addition of glucose measurements to the Leicester Risk Assessment Score (LRAS) improves the prediction of HbA1c ≥42mmol/mol (6.0%) compared with a risk score alone, and reduces the number requiring additional tests to determine their glycaemic status. Method: LRAS and HbA 1c were assessed in 484 participants (aged 40-80 years). 184 participants recruited directly from primary care underwent a fasting glucose measurement while 300 participants recruited through advertisement to the general public attended for a random capillary glucose. Results: A LRAS of ≥17 had a sensitivity of 79.6% and specificity of 60.1% to predict the HbA1c value of ≥42 mmol/mol (6.0%). The addition of a fasting glucose to the LRAS improved the explained variation in HbA1c from 20.8% with a risk score alone to 46.7%. In addition the number of people requiring further assessment of their glucose status was reduced from 43.8% to 33.2%. The addition of a random capillary glucose to the LRAS did not significantly improve the model. Conclusions: The addition of a fasting blood glucose, but not a random capillary glucose, to the LRAS improves the prediction of HbA1c ≥42mmol/mol (6.0%) and reduced the number of people who would need further diagnostic testing for diabetes.

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Screening for Diabetes Mellitus in Adults: The utility of random capillary blood glucose measurements

Abstract: Adjusting random capillary blood glucose measurements for the postprandial period and using age-specific cutoff point values can improve performance of the screening test.

Cited by 56 publications

References 0 publications

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Performance of Recommended Screening Tests for Undiagnosed Diabetes and Dysglycemia

Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2

The use of glucose measurements to improve screening for diabetes in clinical practice

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