Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China

To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and...

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Bibliographic Details
Published in:PloS one 2015-03, Vol.10 (3), p.e0119510-e0119510
Main Authors: Bao, Chundan, Zhang, Dianfeng, Sun, Bo, Lan, Li, Cui, Wenxiu, Xu, Guohua, Sui, Conglan, Wang, Yibaina, Zhao, Yashuang, Wang, Jian, Li, Hongyuan
Format: Article
Language:English
Subjects:
Adult
Aged
Biomarkers - blood
Blood Glucose - metabolism
China - epidemiology
Criteria
Cross-Sectional Studies
Diabetes
Diabetes mellitus
Diabetes Mellitus - blood
Diabetes Mellitus - diagnosis
Diabetes Mellitus - epidemiology
Diabetes Mellitus - prevention & control
Disease control
Disease prevention
Epidemiology
Estimation
Fasting
Female
Glucose
Glucose Intolerance
Glucose metabolism
Glucose tolerance
Glucose tolerance test
Glucose Tolerance Test - economics
Glucose Tolerance Test - statistics & numerical data
Health screening
Humans
Hyperglycemia - blood
Hyperglycemia - diagnosis
Hyperglycemia - epidemiology
Hyperglycemia - prevention & control
Laboratory testing
Male
Mass Screening - economics
Mass Screening - statistics & numerical data
Medical screening
Metabolism
Middle Aged
Mortality
Obesity
Physiological aspects
Population
Population studies
Prediabetic state
Prediabetic State - blood
Prediabetic State - diagnosis
Prediabetic State - epidemiology
Prediabetic State - prevention & control
Prevalence
Public health
Sensitivity and Specificity
Strategy
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Summary:To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0119510