The efficacy and cost of alternative strategies for systematic screening for type 2 diabetes in the US population 45-74 years of age

OBJECTIVE- To simulate the outcomes of alternative strategies for screening the U.S, 0 population 45-74 years of age for type 2 diabetes. RESEARCH DESIGN AND METHODS- We simulated screening with random plasma glucose (RPG) and cut points of 100, 130, and 160 mg/dl and a multivariate equation including RPG and other variables. Over 15 years, we simulated screening at intervals of 1, 3, and 5 years. All positive screening tests were followed by a diagnostic fasting plasma Glucose or an oral glucose tolerance test. Outcomes include the numbers of false-negative, true-positive, and false-positive screening tests and the direct and indirect costs. RESULTS- At year 15, screening every 3 years with an RPG cut point of 100 mg/dl left 0.2 million false negatives, in RPG of 130 mg/dl or the equation left 1.3 million false negatives, and an RPG of 160 mg/dl left 2.8 million false negatives. Over 15 years, the absolute difference between the most sensitive and most specific screening strategy was 4.5 million true Positives and 476 million false-positives. Strategies using RPG cut points of 130 mg/dl or the multivariate n equation every 3 years identified 17.3 million true positives however, the equation identified fewer false-positives. The total Cost Of the most Sensitive screening strategy was $42.7 billion and that Of the most specific strategy, was $6.9 billion. CONCLUSIONS- Screening for type 2 diabetes every 3 years with an RPG cut point of 130 n mg/dl or the multivariate equation provides good yield and minimizes false-positive Screening tests and Costs.