Bracco, Paula Andreghetto and Schmidt, Maria Inês and Vigo, Alvaro and Mill, José Geraldo and Vidigal, Pedro Guatimosim and Barreto, Sandhi Maria and Sander, Mária de Fátima and da Fonseca, Maria de Jesus Mendes and Duncan, Bruce Bartholow (2023) Optimizing strategies to identify high risk of developing type 2 diabetes. Frontiers in Endocrinology, 14. ISSN 1664-2392
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Abstract
Introduction: The success of diabetes prevention based on early treatment depends on high-quality screening. This study compared the diagnostic properties of currently recommended screening strategies against alternative score-based rules to identify those at high risk of developing diabetes.
Methods: The study used data from ELSA-Brasil, a contemporary cohort followed up for a mean (standard deviation) of 7.4 (0.54) years, to develop risk functions with logistic regression to predict incident diabetes based on socioeconomic, lifestyle, clinical, and laboratory variables. We compared the predictive capacity of these functions against traditional pre-diabetes cutoffs of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), and glycated hemoglobin (HbA1c) alone or combined with recommended screening questionnaires.
Results: Presenting FPG > 100 mg/dl predicted 76.6% of future cases of diabetes in the cohort at the cost of labeling 40.6% of the sample as high risk. If FPG testing was performed only in those with a positive American Diabetes Association (ADA) questionnaire, labeling was reduced to 12.2%, but only 33% of future cases were identified. Scores using continuously expressed clinical and laboratory variables produced a better balance between detecting more cases and labeling fewer false positives. They consistently outperformed strategies based on categorical cutoffs. For example, a score composed of both clinical and laboratory data, calibrated to detect a risk of future diabetes ≥20%, predicted 54% of future diabetes cases, labeled only 15.3% as high risk, and, compared to the FPG ≥ 100 mg/dl strategy, nearly doubled the probability of future diabetes among screen positives.
Discussion: Currently recommended screening strategies are inferior to alternatives based on continuous clinical and laboratory variables.
Item Type: | Article |
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Subjects: | STM Academic > Mathematical Science |
Depositing User: | Unnamed user with email support@stmacademic.com |
Date Deposited: | 01 Jul 2023 10:54 |
Last Modified: | 14 Oct 2023 05:38 |
URI: | http://article.researchpromo.com/id/eprint/1215 |