1
|
Pyrros A, Borstelmann SM, Mantravadi R, Zaiman Z, Thomas K, Price B, Greenstein E, Siddiqui N, Willis M, Shulhan I, Hines-Shah J, Horowitz JM, Nikolaidis P, Lungren MP, Rodríguez-Fernández JM, Gichoya JW, Koyejo S, Flanders AE, Khandwala N, Gupta A, Garrett JW, Cohen JP, Layden BT, Pickhardt PJ, Galanter W. Opportunistic detection of type 2 diabetes using deep learning from frontal chest radiographs. Nat Commun 2023; 14:4039. [PMID: 37419921 PMCID: PMC10328953 DOI: 10.1038/s41467-023-39631-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/19/2023] [Indexed: 07/09/2023] Open
Abstract
Deep learning (DL) models can harness electronic health records (EHRs) to predict diseases and extract radiologic findings for diagnosis. With ambulatory chest radiographs (CXRs) frequently ordered, we investigated detecting type 2 diabetes (T2D) by combining radiographic and EHR data using a DL model. Our model, developed from 271,065 CXRs and 160,244 patients, was tested on a prospective dataset of 9,943 CXRs. Here we show the model effectively detected T2D with a ROC AUC of 0.84 and a 16% prevalence. The algorithm flagged 1,381 cases (14%) as suspicious for T2D. External validation at a distinct institution yielded a ROC AUC of 0.77, with 5% of patients subsequently diagnosed with T2D. Explainable AI techniques revealed correlations between specific adiposity measures and high predictivity, suggesting CXRs' potential for enhanced T2D screening.
Collapse
Affiliation(s)
- Ayis Pyrros
- Duly Health and Care, Department of Radiology, Downers Grove, IL, USA.
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, USA.
| | | | | | - Zachary Zaiman
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Kaesha Thomas
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Brandon Price
- Department of Radiology, Florida State University, Tallahassee, FL, USA
| | - Eugene Greenstein
- Department of Cardiology, Duly Health and Care, Downers Grove, IL, USA
| | - Nasir Siddiqui
- Duly Health and Care, Department of Radiology, Downers Grove, IL, USA
| | - Melinda Willis
- Duly Health and Care, Department of Radiology, Downers Grove, IL, USA
| | | | - John Hines-Shah
- Duly Health and Care, Department of Radiology, Downers Grove, IL, USA
| | | | - Paul Nikolaidis
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Matthew P Lungren
- Department of Biomedical and Health Information Sciences, UCSF, San Francisco, CA, USA
- Center for Artificial Intelligence in Medicine, Stanford University, Stanford, CA, USA
- Microsoft, Microsoft Corporation, Redmond, USA
| | | | | | - Sanmi Koyejo
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John W Garrett
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Joseph Paul Cohen
- Center for Artificial Intelligence in Medicine, Stanford University, Stanford, CA, USA
| | - Brian T Layden
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | | | - William Galanter
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians. Sci Rep 2022; 12:9174. [PMID: 35655080 PMCID: PMC9163110 DOI: 10.1038/s41598-022-13372-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.
Collapse
|
3
|
Abstract
Overt type 2 diabetes mellitus (T2DM) is preceded by prediabetes and latent diabetes (lasts 9-12 years). Key dysglycemia screening tests are fasting plasma glucose and hemoglobin A1C. Screen-detected T2DM benefits from multifactorial management of cardiovascular risk beyond glycemia. Prediabetes is best addressed by lifestyle modification, with the goal of preventing T2DM. Although there is no trial evidence of prediabetes/T2DM screening effectiveness, simulations suggest that clinic-based opportunistic screening of high-risk individuals is cost-effective. The most rigorous extant recommendations are those of the American Diabetes Association and US Preventive Services Task Force, which advise opportunistic 3-yearly screening.
Collapse
Affiliation(s)
- Daisy Duan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive Parowvallei, PO Box 19070, Tygerberg, Cape Town 7505, South Africa
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA; Welch Prevention Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
4
|
Viswambharan H, Cheng CW, Kain K. Differential associations of ankle and brachial blood pressures with diabetes and cardiovascular diseases: cross-sectional study. Sci Rep 2021; 11:9406. [PMID: 33931717 PMCID: PMC8087686 DOI: 10.1038/s41598-021-88973-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Increased brachial systolic blood-pressure (BP) predicts diabetes (T2DM) but is not fully effective. Value of absolute ankle systolic BP for T2DM compared to brachial systolic BP is not known. Our objectives were to assess independent relationships of ankle-systolic BP with T2DM and cardiovascular disease in Europeans and south Asians. Cross-sectional studies of anonymised data from registered adults (n = 1087) at inner city deprived primary care practices. Study includes 63.85% ethnic minority. Systolic BP of the left and right-brachial, posterior-tibial and dorsalis-pedis-arteries measured using a Doppler probe. Regression models' factors were age, sex, ethnicity, body mass index (BMI) and waist height ratio (WHtR). Both brachial and ankle systolic-BP increase with diabetes in Europeans and south Asians. We demonstrated that there was a significant positive independent association of ankle BP with diabetes, regardless of age and sex compared to Brachial. There was stronger negative association of ankle blood pressure with cardiovascular disease, after adjustment for BMI, WHtR and ethnicity. Additionally, we found that ankle BP were significantly associated with cardiovascular disease in south Asians more than the Europeans; right posterior tibial. Ankle systolic BPs are superior to brachial BPs to identify risks of Type 2DM and cardiovascular diseases for enhanced patient care.
Collapse
Affiliation(s)
- Hema Viswambharan
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK.
| | - Chew Weng Cheng
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Kirti Kain
- NHS England & NHS Improvement (North East and Yorkshire), Quarry Hill, Leeds, LS2 7UE, UK
| |
Collapse
|
5
|
Obinwa U, Pérez A, Lingvay I, Meneghini L, Halm EA, Bowen ME. Multilevel Variation in Diabetes Screening Within an Integrated Health System. Diabetes Care 2020; 43:1016-1024. [PMID: 32139383 PMCID: PMC7171943 DOI: 10.2337/dc19-1622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Variation in diabetes screening in clinical practice is poorly described. We examined the interplay of patient, provider, and clinic factors explaining variation in diabetes screening within an integrated health care system in the U.S. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of primary care patients aged 18-64 years with two or more outpatient visits between 2010 and 2015 and no diagnosis of diabetes according to electronic health record (EHR) data. Hierarchical three-level models were used to evaluate multilevel variation in screening at the patient, provider, and clinic levels across 12 clinics. Diabetes screening was defined by a resulted gold standard screening test. RESULTS Of 56,818 patients, 70% completed diabetes screening with a nearly twofold variation across clinics (51-92%; P < 0.001). Of those meeting American Diabetes Association (ADA) (69%) and U.S. Preventive Services Task Force (USPSTF) (36%) screening criteria, three-quarters were screened with a nearly twofold variation across clinics (ADA 53-92%; USPSTF 49-93%). The yield of ADA and USPSTF screening was similar for diabetes (11% vs. 9%) and prediabetes (38% vs. 36%). Nearly 70% of patients not eligible for guideline-based screening were also tested. The USPSTF guideline missed more cases of diabetes (6% vs. 3%) and prediabetes (26% vs. 19%) than the ADA guideline. After adjustment for patient, provider, and clinic factors and accounting for clustering, twofold variation in screening by provider and clinic remained (median odds ratio 1.97; intraclass correlation 0.13). CONCLUSIONS Screening practices vary widely and are only partially explained by patient, provider, and clinic factors available in the EHR. Clinical decision support and system-level interventions are needed to optimize screening practices.
Collapse
Affiliation(s)
- Udoka Obinwa
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Adriana Pérez
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Ildiko Lingvay
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Luigi Meneghini
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.,Parkland Health & Hospital System, Dallas, TX
| | - Ethan A Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael E Bowen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX .,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
6
|
Fazio S, Edwards J, Miyamoto S, Henderson S, Dharmar M, Young HM. More than A1C: Types of success among adults with type-2 diabetes participating in a technology-enabled nurse coaching intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:106-112. [PMID: 30172572 PMCID: PMC6289853 DOI: 10.1016/j.pec.2018.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Success in diabetes research and self-management is often defined as a significant decrease in glycated hemoglobin (A1C). The aim of this article is to explore different types of successes experienced by adults with type-2 diabetes participating in a health technology and nurse coaching clinical trial. METHODS A qualitative analysis was conducted using surveys and documentation from motivational interview-based coaching sessions between study nurses and intervention participants. RESULTS Of the 132 cases reviewed, types of success predominantly fell into five categories: 1) change in health behaviors; 2) change in mindset or awareness; 3) change in engagement with healthcare resources; 4) change in physical or emotional health; and 5) change in health indicators. CONCLUSION Experiences of success in diabetes are more varied than traditional A1C-based outcome models. Our findings suggest coaching and technology can assist patients to achieve a range of successes in diabetes management through goal setting, health tracking, resolving barriers, and aligning goals with factors that impact change. PRACTICE IMPLICATIONS While A1C reduction is a critical factor in decreasing risk of diabetes-related complications, when healthcare professionals focus on A1C as the main indicator of diabetes management success, important changes in individuals' health and well-being may be overlooked or undervalued.
Collapse
Affiliation(s)
- Sarina Fazio
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA; UC Davis Medical Center, UC Davis Health.
| | - Jennifer Edwards
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA.
| | - Sheridan Miyamoto
- College of Nursing, The Pennsylvania State University, University Park, USA.
| | - Stuart Henderson
- Schools of Health Evaluation, Clinical and Translational Science Center, University of California Davis, Sacramento, USA.
| | - Madan Dharmar
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA; Department of Pediatrics, School of Medicine, Betty Irene Moore School of Nursing University of California, Davis, Sacramento, USA.
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, USA.
| |
Collapse
|
7
|
O'Brien MJ, Bullard KM, Zhang Y, Gregg EW, Carnethon MR, Kandula NR, Ackermann RT. Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes. J Gen Intern Med 2018; 33:1100-1108. [PMID: 29651678 PMCID: PMC6025671 DOI: 10.1007/s11606-018-4436-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/29/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 2015, The US Preventive Services Task Force (USPSTF) recommended screening for prediabetes and undiagnosed diabetes (collectively called dysglycemia) among adults aged 40-70 years with overweight or obesity. The recommendation suggests that clinicians consider screening earlier in people who have other diabetes risk factors. OBJECTIVE To compare the performance of limited and expanded screening criteria recommended by the USPSTF for detecting dysglycemia among US adults. DESIGN Cross-sectional analysis of survey and laboratory data collected from nationally representative samples of the civilian, noninstitutionalized US adult population. PARTICIPANTS A total of 3643 adults without diagnosed diabetes who underwent measurement of hemoglobin A1c (A1c), fasting plasma glucose (FPG), and 2-h plasma glucose (2-h PG). MAIN MEASURES Screening eligibility according to the limited criteria was based on age 40 to 70 years old and overweight/obesity. Screening eligibility according to the expanded criteria was determined by meeting the limited criteria or having ≥ 1 of the following risk factors: family history of diabetes, history of gestational diabetes or polycystic ovarian syndrome, and non-white race/ethnicity. Dysglycemia was defined by A1c ≥ 5.7%, FPG ≥ 100 mg/dL, and/or 2-h PG ≥ 140 mg/dL. KEY RESULTS Among the US adult population without diagnosed diabetes, 49.7% had dysglycemia. Screening based on the limited criteria demonstrated a sensitivity of 47.3% (95% CI, 44.7-50.0%) and specificity of 71.4% (95% CI, 67.3-75.2%). The expanded criteria yielded higher sensitivity [76.8% (95% CI, 73.5-79.8%)] and lower specificity [33.8% (95% CI, 30.1-37.7%)]. Point estimates for the sensitivity of the limited criteria were lower in all minority groups and significantly different for Asians compared to non-Hispanic whites [29.9% (95% CI, 23.4-37.2%) vs. 49.8% (95% CI, 45.9-53.7%); P < .001]. CONCLUSIONS Diabetes screening that follows the limited USPSTF criteria will identify approximately half of US adults with dysglycemia. Screening other high-risk subgroups defined in the USPSTF recommendation would improve detection of dysglycemia and may reduce associated racial/ethnic disparities.
Collapse
Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Community Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
8
|
Wu WC, Taveira TH, Jeffery S, Jiang L, Tokuda L, Musial J, Cohen LB, Uhrle F. Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial. PLoS One 2018; 13:e0195898. [PMID: 29672567 PMCID: PMC5908172 DOI: 10.1371/journal.pone.0195898] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/29/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The effectiveness and costs associated with addition of pharmacist-led group medical visits to standard care for patients with Type-2 Diabetes Mellitus (T2DM) is unknown. METHODS Randomized-controlled-trial in three US Veteran Health Administration (VHA) Hospitals, where 250 patients with T2DM, HbA1c >7% and either hypertension, active smoking or hyperlipidemia were randomized to either (1) addition of pharmacist-led group-medical-visits or (2) standard care alone for 13 months. Group (4-6 patients) visits consisted of 2-hour, education and comprehensive medication management sessions once weekly for 4 weeks, followed by quarterly visits. Change from baseline in cardiovascular risk estimated by the UKPDS-risk-score, health-related quality-of-life (SF36v) and institutional healthcare costs were compared between study arms. RESULTS After 13 months, both groups had similar and significant improvements from baseline in UKPDS-risk-score (-0.02 ±0.09 and -0.04 ±0.09, group visit and standard care respectively, adjusted p<0.05 for both); however, there was no significant difference between the study arms (adjusted p = 0.45). There were no significant differences on improvement from baseline in A1c, systolic-blood-pressure, and LDL as well as health-related quality-of-life measures between the study arms. Compared to 13 months prior, the increase in per-person outpatient expenditure from baseline was significantly lower in the group visit versus the standard care arm, both during the study intervention period and at 13-months after study interventions. The overall VHA healthcare costs/person were comparable between the study arms during the study period (p = 0.15); then decreased by 6% for the group visit but increased by 13% for the standard care arm 13 months post-study (p<0.01). CONCLUSIONS Addition of pharmacist-led group medical visits in T2DM achieved similar improvements from baseline in cardiovascular risk factors than usual care, but with reduction in the healthcare costs in the group visit arm 13 months after completion compared to the steady rise in cost for the usual care arm. TRIAL REGISTRATION NCT00554671 ClinicalTrials.gov.
Collapse
Affiliation(s)
- Wen-Chih Wu
- Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, VA Medical Center, Providence, RI
- Department of Medicine, Brown University, Providence, RI
- University of Rhode Island College of Pharmacy, Kingston, RI
| | - Tracey H. Taveira
- Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, VA Medical Center, Providence, RI
- Department of Medicine, Brown University, Providence, RI
- University of Rhode Island College of Pharmacy, Kingston, RI
| | - Sean Jeffery
- University of Connecticut School of Pharmacy, Storrs, CT
- West Haven VA Medical Center, West Haven, CT
| | - Lan Jiang
- Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, VA Medical Center, Providence, RI
| | - Lisa Tokuda
- VA Pacific Islands Health Care System, Honolulu, HI
| | - Joanna Musial
- University of Connecticut School of Pharmacy, Storrs, CT
| | - Lisa B. Cohen
- Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, VA Medical Center, Providence, RI
- University of Rhode Island College of Pharmacy, Kingston, RI
| | - Fred Uhrle
- VA Pacific Islands Health Care System, Honolulu, HI
| |
Collapse
|
9
|
Moin T, Damschroder LJ, Youles B, Makki F, Billington C, Yancy W, Maciejewski ML, Kinsinger LS, Weinreb JE, Steinle N, Richardson C. Implementation of a prediabetes identification algorithm for overweight and obese Veterans. ACTA ACUST UNITED AC 2018; 53:853-862. [PMID: 28273326 DOI: 10.1682/jrrd.2015.06.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/30/2016] [Indexed: 11/05/2022]
Abstract
Type 2 diabetes prevention is an important national goal for the Veteran Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Veterans at Department of Veterans Affairs (VA) medical centers (VAMCs) in preparation for the launch of a pragmatic study of Diabetes Prevention Program (DPP) delivery to Veterans with prediabetes. This project was embedded within the VA DPP Clinical Demonstration Project conducted in 2012 to 2015. Veterans who attended orientation sessions for an established VHA weight-loss program (MOVE!) were recruited from VAMCs with geographically and racially diverse populations using existing referral processes. Each site implemented and adapted the prediabetes identification algorithm to best fit their local clinical context. Sites relied on an existing referral process in which a prediabetes identification algorithm was implemented in parallel with existing clinical flow; this approach limited the number of overweight and obese Veterans who were assessed and screened. We evaluated 1,830 patients through chart reviews, interviews, and/or laboratory tests. In this cohort, our estimated prevalence rates for normal glycemic status, prediabetes, and diabetes were 29% (n = 530), 28% (n = 504), and 43% (n = 796), respectively. Implementation of targeted prediabetes identification programs requires careful consideration of how prediabetes assessment and screening will occur.
Collapse
Affiliation(s)
- Tannaz Moin
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Bradley Youles
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Fatima Makki
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Charles Billington
- Minneapolis VA Health Care System, Minneapolis, MN; and University of Minnesota Medical Center, Minneapolis, MN
| | - William Yancy
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Matthew L Maciejewski
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Linda S Kinsinger
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC
| | - Jane E Weinreb
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Nanette Steinle
- Baltimore VAMC, Baltimore, MD; and University of Maryland School of Medicine, Baltimore, MD
| | - Caroline Richardson
- VA Center for Clinical Management Research, Ann Arbor, MI.,Department of Family Medicine, University of Michigan, Ann Arbor, MI; and Diabetes Quality Enhancement Research Initiative (QUERI), VA, Ann Arbor, MI
| |
Collapse
|
10
|
Bowen ME, Xuan L, Lingvay I, Halm EA. Performance of a Random Glucose Case-Finding Strategy to Detect Undiagnosed Diabetes. Am J Prev Med 2017; 52:710-716. [PMID: 28279547 PMCID: PMC5438773 DOI: 10.1016/j.amepre.2017.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/17/2016] [Accepted: 01/12/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Random glucose <200 mg/dL is associated with undiagnosed diabetes but not included in screening guidelines. This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. METHODS In 2015, cross-sectional data from non-fasting adults without diagnosed diabetes or prediabetes (N=7,161) in the 2007-2012 National Health and Nutrition Examination Surveys were analyzed. Random glucose and survey data were used to assemble the random glucose, American Diabetes Association (ADA), and U.S. Preventive Services Task Force (USPSTF) screening strategies and predict diabetes using hemoglobin A1c criteria. RESULTS Using random glucose ≥100 mg/dL to select individuals for diabetes testing was 81.6% (95% CI=74.9%, 88.4%) sensitive, 78% (95% CI=76.6%, 79.5%) specific and had an area under the receiver operating curve (AROC) of 0.80 (95% CI=0.78, 0.83) to detect undiagnosed diabetes. Overall performance of ADA (AROC=0.59, 95% CI=0.58, 0.60), 2008 USPSTF (AROC=0.62, 95% CI=0.59, 0.65), and 2015 USPSTF (AROC=0.64, 95% CI=0.61, 0.67) guidelines was similar. The random glucose strategy correctly identified one case of undiagnosed diabetes for every 14 people screened, which was more efficient than ADA (number needed to screen, 35), 2008 USPSTF (44), and 2015 USPSTF (32) guidelines. CONCLUSIONS Using random glucose ≥100 mg/dL to identify individuals in need of diabetes screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection. Further evaluation of this strategy's effectiveness in real-world clinical practice is needed.
Collapse
Affiliation(s)
- Michael E Bowen
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Outcomes and Health Services Research, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Lei Xuan
- Division of Outcomes and Health Services Research, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ildiko Lingvay
- Division of Endocrinology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ethan A Halm
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Outcomes and Health Services Research, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
11
|
Elmadhoun WM, Noor SK, Ibrahim AAA, Bushara SO, Ahmed MH. Prevalence of diabetes mellitus and its risk factors in urban communities of north Sudan: Population-based study. J Diabetes 2016; 8:839-846. [PMID: 26663723 DOI: 10.1111/1753-0407.12364] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/10/2015] [Accepted: 12/06/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major health problem in Africa and worldwide. The prevalence of diabetes is expected to increase at alarming rate in Africa. Its estimated that around 20 million Africans are now living with diabetes, comprising a challenge for health systems at present and in the future. The aim of the present study was to determine the prevalence of undiagnosed and diagnosed DM and impaired glucose tolerance (IGT) in adult urban communities of the River Nile State (RNS), north Sudan. METHODS The present study was a cross-sectional community-based study in which participants were randomly selected from the four main cities of the RNS, on a house-to-house basis. Blood glucose was tested and all participants completed a questionnaire to obtain demographic, clinical and social data. Blood pressure and anthropometric measures were also recorded. RESULTS In all, 954 adults (518 females; 54.3%; mean [±SD] age 39.5 ± 16.7 years; range 18-90 years) participated in the survey. The overall prevalence of DM was 19.1% (182/954), whereas that of IGT was 9.5% (91/954). Among the diabetic group, 125 (68.7%) had known diabetes, whereas 57 (31.3%) were newly diagnosed during the study. Increasing age, a family history of diabetes, central obesity, abnormal body mass index, and hypertension were significant risk factors for DM. CONCLUSIONS There is high prevalence of DM and glucose intolerance in the urban population of the RNS. Screening for diabetes in individuals with any feature of metabolic syndrome is recommended.
Collapse
Affiliation(s)
- Wadie M Elmadhoun
- Department of Pathology and Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Sufian K Noor
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | | | - Sarra O Bushara
- Department of Medicine, Faculty of Medicine and Health Sciences, Nile Valley University, Atbara, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK.
| |
Collapse
|
12
|
Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med 2016; 13:e1002074. [PMID: 27403739 PMCID: PMC4942097 DOI: 10.1371/journal.pmed.1002074] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2015, the United States Preventive Services Task Force (USPSTF) recommended targeted screening for prediabetes and diabetes (dysglycemia) in adults who are aged 40 to 70 y old and overweight or obese. Given increasing prevalence of dysglycemia at younger ages and lower body weight, particularly among racial/ethnic minorities, we sought to determine whether the current screening criteria may fail to identify some high-risk population subgroups. METHODS AND FINDINGS We investigated the performance of the 2015 USPSTF screening recommendation in detecting dysglycemia among US community health center patients. A retrospective analysis of electronic health record (EHR) data from 50,515 adult primary care patients was conducted. Longitudinal EHR data were collected in six health centers in the Midwest and Southwest. Patients with a first office visit between 2008 and 2010 were identified and followed for up to 3 y through 2013. We excluded patients who had dysglycemia at baseline and those with fewer than two office visits during the follow-up period. The exposure of interest was eligibility for screening according to the 2015 USPSTF criteria. The primary outcome was development of dysglycemia during follow-up, determined by: (1) laboratory results (fasting/2-h postload/random glucose ≥ 100/140/200 mg/dL [5.55/7.77/11.10 mmol/L] or hemoglobin A1C ≥ 5.7% [39 mmol/mol]); (2) diagnosis codes for prediabetes or type 2 diabetes; or (3) antidiabetic medication order. At baseline, 18,846 (37.3%) participants were aged ≥40 y, 33,537 (66.4%) were overweight or obese, and 39,061 (77.3%) were racial/ethnic minorities (34.6% Black, 33.9% Hispanic/Latino, and 8.7% Other). Overall, 29,946 (59.3%) patients had a glycemic test within 3 y of follow-up, and 8,478 of them developed dysglycemia. Only 12,679 (25.1%) patients were eligible for screening according to the 2015 USPSTF criteria, which demonstrated the following sensitivity and specificity (95% CI): 45.0% (43.9%-46.1%) and 71.9% (71.3%-72.5%), respectively. Racial/ethnic minorities were significantly less likely to be eligible for screening yet had higher odds of developing dysglycemia than whites (odds ratio [95% CI]: Blacks 1.24 [1.09-1.40]; Hispanics 1.46 [1.30-1.64]; and Other 1.33 [1.16-1.54]). In addition, the screening criteria had lower sensitivity in all racial/ethnic minority groups compared to whites. Limitations of this study include the ascertainment of dysglycemia only among patients with available test results and findings that may not be generalizable at the population level. CONCLUSIONS Targeted diabetes screening based on new USPSTF criteria may detect approximately half of adult community health center patients with undiagnosed dysglycemia and proportionately fewer racial/ethnic minorities than whites. Future research is needed to estimate the performance of these screening criteria in population-based samples.
Collapse
|
13
|
Unnikrishnan R, Mohan V. Why screening for type 2 diabetes is necessary even in poor resource settings. J Diabetes Complications 2015; 29:961-4. [PMID: 26099834 DOI: 10.1016/j.jdiacomp.2015.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/28/2022]
Abstract
Screening for type 2 diabetes (T2DM) remains controversial, in spite of the explosive increase in the prevalence of the disorder and the morbidity and mortality associated with its complications. In this review, we attempt to show that T2DM is an ideal candidate disease for screening, and why screening is needed to improve clinical outcomes and prevent complications. We also suggest that screening can be made more cost-effective by adopting a targeted approach and utilizing low-cost tools. We conclude that screening for T2DM is warranted even in resource-constrained settings, and provide examples from rural India showing that such an approach is feasible with meticulous planning and judicious allocation of resources.
Collapse
Affiliation(s)
- Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India.
| |
Collapse
|
14
|
Bullard KM, Ali MK, Imperatore G, Geiss LS, Saydah SH, Albu JB, Cowie CC, Sohler N, Albright A, Gregg EW. Receipt of Glucose Testing and Performance of Two US Diabetes Screening Guidelines, 2007-2012. PLoS One 2015; 10:e0125249. [PMID: 25928306 PMCID: PMC4416019 DOI: 10.1371/journal.pone.0125249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Screening guidelines are used to help identify prediabetes and diabetes before implementing evidence-based prevention and treatment interventions. We examined screening practices benchmarking against two US guidelines, and the capacity of each guideline to identify dysglycemia. METHODS Using 2007-2012 National Health and Nutrition Examination Surveys, we analyzed nationally-representative, cross-sectional data from 5,813 fasting non-pregnant adults aged ≥20 years without self-reported diabetes. We examined proportions of adults eligible for diagnostic glucose testing and those who self-reported receiving testing in the past three years, as recommended by the American Diabetes Association (ADA) and the US Preventive Services Task Force (USPSTF-2008) guidelines. For each screening guideline, we also assessed sensitivity, specificity, and positive (PPV) and negative predictive values in identifying dysglycemia (defined as fasting plasma glucose ≥100 mg/dl or hemoglobin A1c ≥5.7%). RESULTS In 2007-2012, 73.0% and 23.7% of US adults without diagnosed diabetes met ADA and USPSTF-2008 criteria for screening, respectively; and 91.5% had at least one major risk factor for diabetes. Of those ADA- or USPSTF-eligible adults, about 51% reported being tested within the past three years. Eligible individuals not tested were more likely to be lower educated, poorer, uninsured, or have no usual place of care compared to tested eligible adults. Among adults with ≥1 major risk factor, 45.7% reported being tested, and dysglycemia yields (i.e., PPV) ranged from 45.8% (high-risk ethnicity) to 72.6% (self-reported prediabetes). ADA criteria and having any risk factor were more sensitive than the USPSTF-2008 guideline (88.8-97.7% vs. 31.0%) but less specific (13.5-39.7% vs. 82.1%) in recommending glucose testing, resulting in lower PPVs (47.7-54.4% vs. 58.4%). CONCLUSION Diverging recommendations and variable performance of different guidelines may be impeding national diabetes prevention and treatment efforts. Efforts to align screening recommendations may result in earlier identification of adults at high risk for prediabetes and diabetes.
Collapse
Affiliation(s)
- Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mohammed K. Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Linda S. Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon H. Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanine B. Albu
- St. Luke's-Roosevelt Hospital Center, Department of Medicine, Columbia University, New York, New York, United States of America
| | - Catherine C. Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nancy Sohler
- Sophie Davis School of Biomedical Education of The City College of New York, New York, New York, United States of America
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
15
|
Casagrande SS, Cowie CC, Genuth SM. Self-reported prevalence of diabetes screening in the U.S., 2005-2010. Am J Prev Med 2014; 47:780-7. [PMID: 25241199 PMCID: PMC4254011 DOI: 10.1016/j.amepre.2014.07.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/20/2014] [Accepted: 07/21/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early detection of type 2 diabetes has the potential to prevent complications, but the prevalence of opportunistic screening is unknown. PURPOSE To describe the prevalence of diabetes screening by demographic and diabetes-related factors and to determine predictors of screening among a representative U.S. population without self-reported diabetes. METHODS Cross-sectional data were obtained from the 2005-2010 National Health and Nutrition Examination Survey (n=15,125) and 2006 National Health Interview Survey (n=21,519). Participants were aged ≥20 years and self-reported having a diabetes screening test in the past 3 years. Diabetes screening prevalence was analyzed according to risk factors recommended by the American Diabetes Association. Logistic regression was used to determine significant predictors of diabetes screening. Analysis was conducted in 2012-2013. RESULTS The prevalence of having a blood test for diabetes in the past 3 years was 42.1% in 2005-2006, 41.6% in 2007-2008, and 46.8% in 2009-2010. This prevalence increased with age and was higher for women, non-Hispanic whites, and those with more education and income (p<0.001 for all). BMI ≥25, age ≥45 years, having a relative with diabetes, hypertension, glycosylated hemoglobin ≥5.7%, and cardiovascular disease history were significant predictors of screening. For each additional risk factor, the likelihood of screening increased by 51%. CONCLUSIONS Nearly half of the adult population reported having a diabetes screening test. However, testing was less prevalent in minorities and those with lower socioeconomic status. Public health efforts to address these deficiencies in screening are needed.
Collapse
Affiliation(s)
| | - Catherine C Cowie
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Saul M Genuth
- Division of Clinical and Molecular Endocrinology, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
16
|
Kidney RSM, Peacock JM, Smith SA. Blood glucose screening rates among Minnesota adults with hypertension, Behavioral Risk Factor Surveillance System, 2011. Prev Chronic Dis 2014; 11:E207. [PMID: 25427315 PMCID: PMC4247121 DOI: 10.5888/pcd11.140204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Many US adults have multiple chronic conditions, and hypertension and diabetes are among the most common dyads. Diabetes and prediabetes prevalence are increasing, and both conditions negatively affect cardiovascular health. Early diagnosis and treatment of diabetes and prediabetes can benefit people with hypertension by preventing cardiovascular complications. Methods We analyzed 2011 Minnesota Behavioral Risk Factor Surveillance System data to describe the proportion of adults with hypertension screened for diabetes according to US Preventive Services Task Force Recommendations for blood glucose testing. Covariates associated with lower odds of recent screening among adults without diabetes were determined using weighted logistic regression. Results Of Minnesota adults with self-reported hypertension, 19.6% had a diagnosis of diabetes and 10.7% had a diagnosis of prediabetes. Nearly one-third of adults with hypertension without diabetes had not received blood glucose screening in the past 3 years. Factors associated with greater odds of not being screened in multivariable models included being aged 18 to 44 years (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.23–2.55); being nonobese, with stronger effects for normal body mass index; having no check-up in the past 2 years (AOR, 2.49; 95% CI, 1.49–4.17); having hypertension treated with medication (AOR, 2.01; 95% CI, 1.49–2.71); and completing less than a college degree (AOR, 1.45; 95% CI, 1.14–1.84). Excluding respondents with prediabetes or those not receiving a check-up did not change the results. Conclusions Failure to screen among providers and failure to understand the importance of screening among individuals with hypertension may mean missed opportunities for early detection, clinical management, and prevention of diabetes.
Collapse
Affiliation(s)
- Renée S M Kidney
- Minnesota Department of Health, Division of Health Promotion and Chronic Disease, Center for Health Promotion, Diabetes Unit, PO Box 64882, St Paul, MN 55164-5429. E-mail:
| | | | - Steven A Smith
- Mayo Clinic, Rochester, Minnesota. Dr Smith is also affiliated with the Mayo College of Medicine, Rochester, Minnesota
| |
Collapse
|
17
|
Chung S, Azar KMJ, Baek M, Lauderdale DS, Palaniappan LP. Reconsidering the age thresholds for type II diabetes screening in the U.S. Am J Prev Med 2014; 47:375-81. [PMID: 25131213 PMCID: PMC4171212 DOI: 10.1016/j.amepre.2014.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/18/2014] [Accepted: 05/12/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Type II diabetes and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent. PURPOSE To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines. METHODS Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007-2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014. RESULTS NNS, under universal screening, drops sharply at age 35 years, from 80 (30-34-year-olds) to 31 (35-39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35-44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide). CONCLUSIONS Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.
Collapse
Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto.
| | | | - Marshall Baek
- Palo Alto Medical Foundation Research Institute, Palo Alto
| | | | - Latha P Palaniappan
- Palo Alto Medical Foundation Research Institute, Palo Alto; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
18
|
Tennis Elbow Repair With or Without Suture Anchors. TECHNIQUES IN SHOULDER & ELBOW SURGERY 2014. [DOI: 10.1097/bte.0000000000000027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Dall TM, Narayan KMV, Gillespie KB, Gallo PD, Blanchard TD, Solcan M, O’Grady M, Quick WW. Detecting type 2 diabetes and prediabetes among asymptomatic adults in the United States: modeling American Diabetes Association versus US Preventive Services Task Force diabetes screening guidelines. Popul Health Metr 2014; 12:12. [PMID: 24904239 PMCID: PMC4045861 DOI: 10.1186/1478-7954-12-12] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/23/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Screening to detect prediabetes and diabetes enables early prevention and intervention. This study describes the number and characteristics of asymptomatic, undiagnosed adults in the United States who could be detected with prediabetes and type 2 diabetes using the American Diabetes Association (ADA) guidelines compared to the United States Preventive Services Task Force (USPSTF) guidelines. METHODS We developed predictive models for undiagnosed diabetes and prediabetes using polytomous logistic regression from data on risk factors in the 2003-2010 National Health and Nutrition Examination Survey (n = 19,056). We applied these predictive models to the 2010 Medical Expenditure Panel Survey, which contains health care use data, to generate probabilities of undiagnosed diabetes and undetected prediabetes for each adult. We summed individual probabilities to estimate the number of adults who would be detected with prediabetes and/or type 2 diabetes if screened under ADA or USPSTF guidelines. We analyzed health care use patterns of people at high risk for diabetes. RESULTS In 2010, 59.1 million adults met the USPSTF screening criteria including 24.4 million people with undetected prediabetes and 3.7 million people with undiagnosed diabetes. In comparison, among the 86.3 million people who met the ADA screening criteria, there were 33.9 million with undetected prediabetes and 4.6 million with undiagnosed type 2 diabetes. The ADA guidelines detected 38.9% more cases of prediabetes and 24.3% more cases of type 2 diabetes compared to the USPSTF guidelines. Subgroup analysis showed that ADA guidelines would detect 78% more cases of diabetes among the age 54 and younger population, in 40% more blacks, and in more than twice as many Hispanics than USPSTF guidelines. Only 58% of adults meeting ADA guidelines and 70% meeting USPSTF guidelines had ≥ 1 primary care office visit in 2010. CONCLUSIONS Compared to USPSTF guidelines, ADA guidelines would screen more people and detect more cases of both prediabetes and type 2 diabetes, though a substantial percentage of patients with undetected cases had no contact with a primary care provider in 2010. Addressing the problem of large numbers of undetected prediabetes and type 2 diabetes cases will require new strategies for screening.
Collapse
|
20
|
Campos-Outcalt. U.S. Preventive Services Task Force diabetes screening. Am J Prev Med 2014; 46:e17. [PMID: 24355681 DOI: 10.1016/j.amepre.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/07/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Campos-Outcalt
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine, Phoenix AZ.
| |
Collapse
|
21
|
Aroda VR, Fonseca VA. U.S. Preventive Services Task Force criteria for diabetes screening: time to revisit the evidence? Am J Prev Med 2013; 45:246-7. [PMID: 23867034 DOI: 10.1016/j.amepre.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Vanita R Aroda
- MedStar Health Research Institute, Hyattsville, MD, USA.
| | | |
Collapse
|