Evaluation of a Population-Based Screening for Type 2 Diabetes: A Community-Based Screening Project in Puli, Taiwan

doi:10.1006/pmed.2000.0728

Preventive Medicine

Volume 31, Issue 4, October 2000, Pages 396-402

https://doi.org/10.1006/pmed.2000.0728 Get rights and content

Abstract

Background. A Markov method incorporating the relationships between prevalence, incidence, and mortality with respect to type 2 diabetes was used to assess a population-based screening for this disease.

Methods. Data from a population-based screening project for residents of Puli, Taiwan, over 30 years of age (n= 1,219) were used to estimate the annual incidence of asymptomatic type 2 diabetes, the prevalence to incidence (P/I) ratio, and the hazard rate of death due to type 2 diabetes. These parameters were employed to develop a Markov process to evaluate the effects of early detection of type 2 diabetes on the risk of death from this disease in a simulated population (n= 10,000) receiving biennial, 5-year interval, or no screening.

Results. The estimated annual incidence, average duration from asymptomatic to symptomatic type 2 diabetes (P/I ratio), and hazard rate for death from this disease were 0.86% (95% CI 0.50–1.48), 10 years (95% CI 7.69–14.01), and 1.1% per year, respectively. This yields an optimal screening interval of 5 years. Simulation of a 5-year interval screening regimen versus no screen ing yielded a relative risk reduction of 31% (95% CI 12–46%). A similar value was found for a biennial screening regime.

Conclusions. The results suggest that early detection of type 2 diabetes via a community-based screening project in developing countries with high prevalence is worthwhile.

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Cited by (17)

Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): A cluster-randomised controlled trial
2012, The Lancet
Citation Excerpt :
Identification of those at high risk of diabetes also provides opportunities for primary prevention of both diabetes and cardiovascular disease.9 Modelling studies suggest that a programme of screening for diabetes would reduce both diabetes-related and overall mortality,10–12 but these estimates depend on several key assumptions that need confirmation in a randomised trial. We report mortality over a median 9·6 years in a population-based cluster-randomised trial of screening in patients aged 40–69 years at high risk of having undiagnosed diabetes in general practices in eastern England.
The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefits of screening for type 2 diabetes. We assessed the effect of a population-based stepwise screening programme on mortality.
In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40–69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA_1c) tests, a fasting capillary blood glucose test, and a confirmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were flagged for mortality surveillance by the England and Wales Office of National Statistics. Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081.
Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001–06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9·6 years [IQR 8·9–9·9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1·06, 95% CI 0·90–1·25). We noted no significant reduction in cardiovascular (HR 1·02, 95% CI 0·75–1·38), cancer (1·08, 0·90–1·30), or diabetes-related mortality (1·26, 0·75–2·10) associated with invitation to screening.
In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease.
Wellcome Trust; UK Medical Research Council; National Health Service research and development support; UK National Institute for Health Research; University of Aarhus, Denmark; Bio-Rad.
Record-based, stepwise screening for type 2 diabetes integrated into an annual cardiovascular care review system: Findings from a UK general practice
2011, Primary Care Diabetes
Citation Excerpt :
The current ratio of diagnosed to undiagnosed T2DM in England is estimated to be 2:1 [3], and a high proportion of individuals present with evidence of complications at diagnosis [4]. A growing body of evidence suggests that earlier detection and treatment of T2DM might be beneficial [5,6]. Screening does not appear to be associated with psychological harm [7].
Screening high-risk individuals for type 2 diabetes (T2DM) is recommended by many organisations. We report results from a pragmatic stepwise T2DM screening programme integrated into an annual review system in a UK general practice.
Patients with hypertension, cardiovascular disease or chronic kidney disease attending an annual review were screened for dysglycaemia by random blood glucose (RBG) measurement. At the discretion of the usual doctor, individuals with an RBG ≥ 6.1 mmol/l were invited to return for fasting blood glucose (FBG) or HbA_1C measurement, allowing diagnosis of T2DM.
786 eligible patients were invited for T2DM screening as part of their annual review. 544 attended screening, of whom 120 had an RBG ≥ 6.1 mmol/l. 40 individuals attended FBG measurement and 8 individuals attended HbA_1C measurement, leading to 9 T2DM diagnoses. The positive predictive value of the test for T2DM was 19% and the laboratory cost was £91 per patient diagnosed with T2DM.
It is feasible to integrate a simple T2DM screening programme within an annual review system in a UK general practice. Different strategies may be required to increase initial attendance and ensure completion of the screening programme.
Predictive performance of anthropometric indexes of central obesity for the risk of type 2 diabetes
2005, Archives of Medical Research
Citation Excerpt :
With an increasing incidence of type 2 diabetes, developing countries face the challenge of early case detection (52,53). Chang et al. (54) have demonstrated the importance of population level screening for type 2 diabetes. Unfortunately, the case detection methods of diabetes are inherently invasive and more specific than sensitive.
In spite of several available anthropometric indexes, the relative merit of these indexes for the prediction of type 2 diabetes remains unknown. Considering that obesity and diabetes commonly coexist as co-morbidities, our objective was to directly compare the performance of measures of central and general obesity to predict the risk of type 2 diabetes.
We conducted a case-control study of type 2 diabetes on 150 cases and 150 age- and gender-matched controls. We directly compared the predictive performance of five anthropometric indexes: four related to central obesity—waist circumference (WC), waist/hip ratio (WHR), abdominal volume index (AVI) and conicity index (CI); and one related to general obesity—body mass index (BMI). We used various statistical approaches like area under (AUC) receiver-operating characteristic (ROC) curves, likelihood ratios, logistic regression and Shannon's entropy to compare the performance of the indexes in the study sample as well as bootstrapped samples.
WC had the highest overall predictive accuracy that was gender insensitive (AUC = 0.77 in males and 0.74 in females); a comparable information content as that of AVI (Shannon's entropy = 1.81 for WC and 1.84 for AVI) and was a better predictor of the risk of type 2 diabetes than all the remaining indexes. WC also correlated strongly with the biochemical markers of diabetes like blood sugar and lipid profile.
WC is a simple, non-invasive and accurate predictor of the risk of type 2 diabetes that can potentially be used in screening programs in developing countries.
A population dynamic model to assess the diabetes screening and reporting programs and project the burden of undiagnosed diabetes in thailand
2019, International Journal of Environmental Research and Public Health
Incidence, prevalence, and duration of chronic kidney disease in Taiwan: Results from a community-based screening program of 106,094 individuals
2018, Nephron
Effect of screening for type 2 diabetes on risk of cardiovascular disease and mortality: a controlled trial among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009
2017, Diabetologia

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¹: To whom correspondence and reprint requests should be addressed at Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 213, No. 19, Su-Chow, Taipei, Taiwan. Fax: 886-2-23587707.

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Regular ArticleEvaluation of a Population-Based Screening for Type 2 Diabetes: A Community-Based Screening Project in Puli, Taiwan

Abstract

Kelly West Lecture: Undiagnosed NIDDM, clinical, and public health issues

Diabetes Care

Screening for diabetes mellitus

Ann Intern Med

Screening for NIDDM: Opportunities for detection, treatment, and prevention

Diabetes Care

Screening could seriously damage your health

BMJ

Diabetes Care

Onset of NIDDM occurs at least 4–7 years before clinical diagnosis

Diabetes Care

Regular Article
Evaluation of a Population-Based Screening for Type 2 Diabetes: A Community-Based Screening Project in Puli, Taiwan