Genetic predisposition Preclinical state Normal IGT Disability Death Clinical disease Type 2 DM Disability Death Complications Complications Primary Secondary Tertiary prevention prevention prevention Stages in the Natural History of Type 2 diabetes
Random Capillary Blood Glucose Test All Low-risk population e.g., age < 45 RCBG positive High-risk population e.g., age 45 RCBG negative IFG or IGT or DM OGTT & FPG negative OGTT RCBG test
Cost per Case of Undiagnosed Diabetes or Pre-Diabetes Identified by Random Capillary Glucose Test Zhang et al ADA 2004
Cost per Case Identified at the Most Efficient Cutoff Point (single-payer perspective) Zhang et al ADA 2004 5.0% 100 mg/dl 100 mg/dl Cutoff point Screening for pre-diabetes & diabetes $153 $127 $125 $/case $/case Cutoff point $578 110 mg/dl FPG $590 5.7% A1C $392 120 mg/dl RCBG Screening for diabetes alone Test
Follow-up Report on the Diagnosis of Diabetes Mellitus The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Diabetes Care 2003; 26: 3160.
Criteria for Diabetes and Pre-Diabetes Fasting glucose 2-hour glucose Cutpoint lowered to >=100
Fasting Glucose Distribution Glucose level (mg/dl) Number 100 110 126
Pre-Diabetes in the US population 40–74 years of Age by Old and New Criteria, 2000 Total = 20 million Total = 41 million Benjamin et al., CDC unpublished; CDC National Diabetes Fact Sheet. 13 M (4 M) 15 M 35 M (5 M) 16 M OLD NEW IFG IGT & IGT IFG IFG IFG & IGT IGT