Comparison of Screening Tests for Non-Insulin-Dependent Diabetes Mellitus

doi:10.1001/archinte.1993.00410180083010

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Vol. 153 No. 18, 27 SEP 1993

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Comparison of Screening Tests for Non-Insulin-Dependent Diabetes Mellitus

Robert L. Hanson, MD, MPH; Robert G. Nelson, MD, MPH; David R. McCance, MD, MRCP; Jennifer A. Beart; Marie-Aline Charles, MD, MPH; David J. Pettitt, MD; William C. Knowler, MD, DrPH

Arch Intern Med. 1993;153(18):2133-2140.

Abstract

Background
Screening for non-insulin-dependent diabetes mellitus (NIDDM)can be useful in clinical practice and in epidemiologic andgenetic studies, but the available information for choosingbetween screening methods is limited. In this study, characteristicsof several screening tests for NIDDM were compared.

Methods
Among Pima Indians participating in an epidemiologic study,the sensitivity and specificity for detecting NIDDM of fastingplasma glucose (FPG) levels and two measures of glycated hemoglobin(HbA₁ or HbA_1c) were compared in 2092 fasting subjects. Glycatedhemoglobin, quantitative glycosuria, and dipstick glycosuriawere compared in 237 nonfasting subjects. Diabetes was diagnosedusing an oral glucose tolerance test if the 2-hour postloadvenous plasma glucose concentration was 11.1 mmol/L (200 mg/dL)or greater. The area under the relative operating characteristiccurve was used to compare tests.

Results
In fasting subjects, the sensitivity for detecting diabeteswith 98% specificity was 78.8% for HbA₁ level of 7.5% or greater,80.3% for HbA_1c level of 6.3% or greater, and 88.0% for FPGlevel of 6.83 mmol/L (123 mg/dL) or greater. By relative operatingcharacteristic analysis, there were no significant differencesbetween FPG and HbA_1c, but FPG was significantly more sensitivethan HbA₁. In nonfasting subjects the sensitivity at 98% specificitywas 92.9% for HbA₁ level of 7.3% or greater, 80.6% for quantitativeurine glucose level of 1.94 mmol/L (35 mg/dL) or greater, and64.3% for trace or greater of dipstick glycosuria. The areaunder the relative operating characteristic curve was significantlygreater for glycated hemoglobin than for either measure of glycosuria.

Conclusions
Although FPG has the best screening properties, HbA_1c, HbA₁,and quantitative urine glucose also provide high specificityand approximately 80% sensitivity in detecting NIDDM. The choiceof a particular method could depend on cost, convenience, andavailability.

(Arch Intern Med. 1993;153:2133-2140)

Author Affiliations

From the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Ariz. Dr Nelson is now with the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Ariz.

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