Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study

L Chen, Dianna Magliano, Beverley Balkau, Rory Wolfe, Laurie Brown, Andrew Tonkin, Paul Zimmet, Jonathan Shaw

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    Abstract

    Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.

    Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.

    Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3%; 95% confidence interval 76.6–84.1%), specificity (78.1%; 95% confidence interval 76.9–79.2%) and positive predictive value (22.3%; 95% confidence interval 20.2–24.4%) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1%; 95% confidence interval 23.0–25.2%) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.

    Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.
    Original languageEnglish
    Pages (from-to)414-423
    Number of pages10
    JournalDiabetic Medicine
    Volume284
    Issue number4
    DOIs
    Publication statusPublished - 2011

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    Type 2 Diabetes Mellitus
    Cost-Benefit Analysis
    Confidence Intervals
    Costs and Cost Analysis
    Fasting
    Glucose
    Life Style
    Sensitivity and Specificity
    Obesity
    Population

    Cite this

    Chen, L ; Magliano, Dianna ; Balkau, Beverley ; Wolfe, Rory ; Brown, Laurie ; Tonkin, Andrew ; Zimmet, Paul ; Shaw, Jonathan. / Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study. In: Diabetic Medicine. 2011 ; Vol. 284, No. 4. pp. 414-423.
    @article{8aee3858178e40d880ee6b614f39994d,
    title = "Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study",
    abstract = "Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3{\%}; 95{\%} confidence interval 76.6–84.1{\%}), specificity (78.1{\%}; 95{\%} confidence interval 76.9–79.2{\%}) and positive predictive value (22.3{\%}; 95{\%} confidence interval 20.2–24.4{\%}) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1{\%}; 95{\%} confidence interval 23.0–25.2{\%}) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.",
    author = "L Chen and Dianna Magliano and Beverley Balkau and Rory Wolfe and Laurie Brown and Andrew Tonkin and Paul Zimmet and Jonathan Shaw",
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    Chen, L, Magliano, D, Balkau, B, Wolfe, R, Brown, L, Tonkin, A, Zimmet, P & Shaw, J 2011, 'Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study', Diabetic Medicine, vol. 284, no. 4, pp. 414-423. https://doi.org/10.1111/J.1464-5491.2010.03188.X

    Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study. / Chen, L; Magliano, Dianna; Balkau, Beverley; Wolfe, Rory; Brown, Laurie; Tonkin, Andrew; Zimmet, Paul; Shaw, Jonathan.

    In: Diabetic Medicine, Vol. 284, No. 4, 2011, p. 414-423.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Maximising Efficiency and Cost-Effectiveness of Type 2 Diabetes Screening: The AusDiab Study

    AU - Chen, L

    AU - Magliano, Dianna

    AU - Balkau, Beverley

    AU - Wolfe, Rory

    AU - Brown, Laurie

    AU - Tonkin, Andrew

    AU - Zimmet, Paul

    AU - Shaw, Jonathan

    PY - 2011

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    N2 - Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3%; 95% confidence interval 76.6–84.1%), specificity (78.1%; 95% confidence interval 76.9–79.2%) and positive predictive value (22.3%; 95% confidence interval 20.2–24.4%) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1%; 95% confidence interval 23.0–25.2%) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.

    AB - Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3%; 95% confidence interval 76.6–84.1%), specificity (78.1%; 95% confidence interval 76.9–79.2%) and positive predictive value (22.3%; 95% confidence interval 20.2–24.4%) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1%; 95% confidence interval 23.0–25.2%) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.

    U2 - 10.1111/J.1464-5491.2010.03188.X

    DO - 10.1111/J.1464-5491.2010.03188.X

    M3 - Article

    VL - 284

    SP - 414

    EP - 423

    JO - Diabetic Medicine

    JF - Diabetic Medicine

    SN - 0742-3071

    IS - 4

    ER -