Analysis of Guidelines for Screening Diabetes Mellitus in an Ambulatory Population

OBJECTIVES To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population. PATIENTS AND METHODS In this retrospective analysis, we reviewed a database of 46,991 nondiabetic patients...

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Bibliographic Details
Published in:Mayo Clinic proceedings 2010, Vol.85 (1), p.27-35
Main Authors: Sheehy, Ann M., MD, MS, Flood, Grace E., MD, MPH, Tuan, Wen-Jan, MS, MPH, Liou, Jinn-ing, MS, Coursin, Douglas B., MD, Smith, Maureen A., MD, MPH, PhD
Format: Article
Language:English
Subjects:
Adult
Age Factors
Ambulatory Care - standards
Biological and medical sciences
Demographic aspects
Diabetes
Diabetes Mellitus - diagnosis
Diabetes Mellitus - epidemiology
Diabetes Mellitus - etiology
Diabetes. Impaired glucose tolerance
Diagnosis
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
General aspects
Humans
Hypercholesterolemia - complications
Hypertension - complications
Insurance, Health
Internal Medicine
Male
Medical sciences
Medical screening
Methods
Middle Aged
Midwestern United States - epidemiology
Obesity - complications
Original
Practice guidelines (Medicine)
Practice Guidelines as Topic - standards
Prevention and actions
Primary Health Care - standards
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
Risk Factors
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Summary:OBJECTIVES To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population. PATIENTS AND METHODS In this retrospective analysis, we reviewed a database of 46,991 nondiabetic patients aged 20 years and older who were seen at a large Midwestern academic physician practice from January 1, 2005, through December 31, 2007. Patients were included in the sample if they were currently being treated by the physician group according to Wisconsin Collaborative for Healthcare Quality criteria. Pregnant patients, diabetic patients, and patients who died during the study years were excluded. The prevalence of patients who met the American Diabetes Association (ADA) and/or US Preventive Services Task Force (USPSTF) criteria for diabetes screening, percentage of these patients screened, and number of new diabetes diagnoses per guideline were evaluated. Screening rates were assessed by number of high-risk factors, primary care specialty, and insurance status. RESULTS A total of 33,823 (72.0%) of 46,991 patients met either the ADA or the USPSTF screening criteria, and 28,842 (85.3%) of the eligible patients were tested. More patients met the ADA criteria than the 2008 USPSTF criteria (30,790 [65.5%] vs 12,054 [25.6%]), and the 2008 USPSTF guidelines resulted in 460 fewer diagnoses of diabetes (33.1%). By single high-risk factor, prediabetes (15.8%) and polycystic ovarian syndrome (12.6%) produced the highest rates of diagnosis. The number of ADA high-risk factors predicted diabetes, with 6 (23%) of 26 patients with 6 risk factors diagnosed as having diabetes. Uninsured patients were tested significantly less often than insured patients (54.9% vs 85.4%). CONCLUSION Compared with the ADA recommendations, the new USPSTF guidelines result in a lower number of patients eligible for screening and decrease case finding significantly. The number and type of risk factors predict diabetes, and lack of health insurance decreases testing.
ISSN:0025-6196
1942-5546
DOI:10.4065/mcp.2009.0289