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June 2, 1999

Screening for Type 2 Diabetes

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(21):1986-1988. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-21-jbk0602

To the Editor: The improvement in quality of life and health economic benefits of good glycemic control in patients with type 2 diabetes mellitus1 makes even more important the cost-effective analysis of screening for this disease.2 The Centers for Disease Control and Prevention uses a fasting plasma glucose test for screening set at 6.1 mmol/L (110 mg/dL) (sensitivity, 80%; specificity, 90%) before confirmation by an oral glucose tolerance test. But for any chosen specificity, sensitivity can be increased by using a probability estimate of being diabetic, based on both the level of the screening test and the prevalence of diabetes by characteristics of the screened subjects in the population. The characteristics to be considered are age, relatives with diabetes, obesity, and birth weight of screened subject's heaviest child. Basing the decision to perform a confirming oral glucose tolerance test on a probability estimate of being a diabetic is intuitively superior to basing the decision on a fixed fasting plasma glucose level.

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