Scientists have found that not only is early diagnosis of diabetes or prediabetes beneficial to your wellness, but also targeting individuals at greatest risk of diabetes and high-risk prediabetes, because of their body mass index (BMI), systolic blood pressure (BP), and/or age, would be the most cost-effective approach to screening for the disease.
This is according to a new study of over 1500 adults, published online in Diabetes Care by Ranee Chatterjee, MD, from the Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, and colleagues. The authors specifically found that screening people older than 55 years who have BMIs higher than 35 kg/m 2 and/or systolic BPs higher than 130 mm Hg could provide the greatest cost savings. They also showed that the most inexpensive way of doing this is by performing a plasma glucose level measured after a 50-g oral glucose-challenge test (GCTpl), without prior fasting.
According to Dr Chatterjee, ‘This study highlights that recognizing and treating both early diabetes and prediabetes may result in cost savings, especially in those patients who have even 1 risk factor for these conditions. This study also indicates that a novel screening test, the GCTpl — followed, if abnormal, by an oral glucose tolerance test [OGTT] — may result in the most cost savings.’ He explained that the GCTpl and related CGTcap (capillary glucose measured after an oral glucose challenge) are currently used to screen for gestational diabetes.
However, the approach outlined by Dr Chatterjee’s team differs from the screening recommendations of the American Diabetes Association (ADA). The ADA advises using haemoglobin A1c, fasting plasma glucose or oral glucose tolerance tests every three years, in people aged 45 years and older or all individuals with a BMI of 25 or higher plus 1 additional risk factor.
Richard Grant, MD, MPH, chair of the American Diabetes Association’s Professional Practice Committee, objected to the non-common screening tests used in this study; ‘It compares tests that, with the exception of A1c, are not used in primary care, and it doesn’t include the simplest of all, fasting glucose.’ The tests used in the 1573 adults without a previous diagnosis of diabetes or prediabetes were GCTpl, GCTcap, a random plasma or capillary glucose (RPG or RCG), and haemoglobin A1c.
Dr Chatterjee admitted, ‘Cost savings can result if physicians follow current recommendations. However, it will likely be most cost saving to perform more accurate screening tests for these conditions, such as the glucose-challenge test.’ He concluded by acknowledging that ‘prospective studies in larger populations and over a longer time period are needed to verify our projections of cost savings from screening and treatment.’
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