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: Objective: To identify the optimal AUSDRISK threshold score to screen for pre?diabetes and diabetes. Methods: A total of 406 adult patients not diagnosed with diabetes were screened in General Practices (GP) between May and October 2019. All patients received a point of care (POC) HbA1c test. HbA1c test results were categorised into diabetes (?6.5% or ?48 mmol/mol), pre?diabetes (5.7?6.4% or 39?47 mmol/mol), or normal ( Results: Of these patients, 9 (2%) had undiagnosed diabetes and 60 (15%) had pre?diabetes. A Receiver Operator Characteristic (ROC) curve was constructed to predict the presence of pre?diabetes and diabetes; the area under the ROC curve was 0.72 (95%CI 0.65?0.78) indicating modest predictive ability. The optimal threshold cut point for AUSDRISK score was 17 (sensitivity 76%, specificity 61%, + likelihood ratio (LR) 1.96, ? likelihood ratio of 0.39) while the accepted cut point of 12 performed less well (sensitivity 94%, specificity 23%, +LR=1.22 ?LR+0.26). Conclusions: The AUSDRISK tool has the potential to be used as a screening tool for pre?diabetes/diabetes in GP practices. A cut point of ?17 would potentially identify 75% of all people at risk and three in 10 sent for further testing would be positive for prediabetes or diabetes. Implications for public health: Routine case?finding in high?risk patients will enable GPs to intervene early and prevent further public health burden from the sequelae of diabetes., Pre?diabetes is a condition where a person's fasting glucose is elevated but has not reached the diabetes threshold and it is a significant risk factor for the development of type [...]

The global burden of diabetes is rapidly increasing, from 451 million people in 2019 to 693 million by 2045.sup.1. The insidious onset of type 2 diabetes delays diagnosis and increases morbidity.sup.2. Given the multifactorial vascular effects of diabetes, we hypothesized that smartphone-based photoplethysmography could provide a widely accessible digital biomarker for diabetes. Here we developed a deep neural network (DNN) to detect prevalent diabetes using smartphone-based photoplethysmography from an initial cohort of 53,870 individuals (the 'primary cohort'), which we then validated in a separate cohort of 7,806 individuals (the 'contemporary cohort') and a cohort of 181 prospectively enrolled individuals from three clinics (the 'clinic cohort'). The DNN achieved an area under the curve for prevalent diabetes of 0.766 in the primary cohort (95% confidence interval: 0.750-0.782; sensitivity 75%, specificity 65%) and 0.740 in the contemporary cohort (95% confidence interval: 0.723-0.758; sensitivity 81%, specificity 54%). When the output of the DNN, called the DNN score, was included in a regression analysis alongside age, gender, race/ethnicity and body mass index, the area under the curve was 0.830 and the DNN score remained independently predictive of diabetes. The performance of the DNN in the clinic cohort was similar to that in other validation datasets. There was a significant and positive association between the continuous DNN score and hemoglobin A1c (P [less than or equal to] 0.001) among those with hemoglobin A1c data. These findings demonstrate that smartphone-based photoplethysmography provides a readily attainable, non-invasive digital biomarker of prevalent diabetes. A deep neural network applied to smartphone-based vascular imaging can detect diabetes, opening new possibilities for non-invasive diagnosis., Author(s): Robert Avram [sup.1] , Jeffrey E. Olgin [sup.1] , Peter Kuhar [sup.2] , J. Weston Hughes [sup.3] , Gregory M. Marcus [sup.1] , Mark J. Pletcher [sup.4] , Kirstin [...]

Author(s): X Ma [sup.1] [sup.2] , Y-L Zhang [sup.3] , Q Ji [sup.4] , Y Xing [sup.4] , H Pan [sup.5] , S Chen [sup.5] , J-L Tang [sup.3] , [...]

Background Colorectal cancer (CRC) incidence is increasing among young adults below screening age, despite the effectiveness of screening in older populations. Individuals with diabetes mellitus are at increased risk of early-onset CRC. We aimed to determine how many years earlier than the general population patients with diabetes with/without family history of CRC reach the threshold risk at which CRC screening is recommended to the general population. Methods and findings A nationwide cohort study (follow-up:1964-2015) involving all Swedish residents born after 1931 and their parents was carried out using record linkage of Swedish Population Register, Cancer Registry, National Patient Register, and Multi-Generation Register. Of 12,614,256 individuals who were followed between 1964 and 2015 (51% men; age range at baseline 0-107 years), 162,226 developed CRC, and 559,375 developed diabetes. Age-specific 10-year cumulative risk curves were used to draw conclusions about how many years earlier patients with diabetes reach the 10-year cumulative risks of CRC in 50-year-old men and women (most common age of first screening), which were 0.44% and 0.41%, respectively. Diabetic patients attained the screening level of CRC risk earlier than the general Swedish population. Men with diabetes reached 0.44% risk at age 45 (5 years earlier than the recommended age of screening). In women with diabetes, the risk advancement was 4 years. Risk was more pronounced for those with additional family history of CRC (12-21 years earlier depending on sex and benchmark starting age of screening). The study limitations include lack of detailed information on diabetes type, lifestyle factors, and colonoscopy data. Conclusions Using high-quality registers, this study is, to our knowledge, the first one that provides novel evidence-based information for risk-adapted starting ages of CRC screening for patients with diabetes, who are at higher risk of early-onset CRC than the general population., Author(s): Uzair Ali Khan 1,2, Mahdi Fallah 1,3,*, Kristina Sundquist 3,4,5, Jan Sundquist 3,4,5, Hermann Brenner 1,6,7, Elham Kharazmi 1,3,8 Introduction Colorectal cancer (CRC) has become the third most common [...]

OBJECTIVES: Few have compared socio-economic disparities in screening tests for cancer with recommended tests for other chronic diseases. We examined whether receipt of testing for colorectal, cervical and breast cancer, as well as diabetes and high cholesterol, differs by neighbourhood-level socio-economic and recent immigrant status. METHODS: We conducted a population-based retrospective cohort study of patients identified as screen-eligible in 2009 living in Ontario, Canada. Postal codes were used to assign residents to a dissemination area (DA). Using Canadian census data, DAs were stratified by income quintile and proportion of recent immigrants. Prevalence of screening for cancer (colorectal, cervical, breast), diabetes, and high cholesterol, using administrative data, and prevalence ratios (least/most advantaged) were calculated. RESULTS: The cohort comprised 7,652,592 people. Receipt of screening for colorectal cancer (women 61.6%; men 55.1%) and breast cancer (59.9%) were the lowest and diabetes (women 72.9%; men 61.4%) and high cholesterol (women 82.4%; men 70.3%) were the highest. We found disparities in the receipt of all tests, with the lowest uptake and largest disparities for cancer screening among those living in both low-income and high-immigration DAs: colorectal--women 48.6%; RR 0.77; 95% CI (0.74-0.79) and men 40.6%; RR 0.71 (0.68-0.74); cervical--52.0%; RR 0.80 (0.78-0.81) and breast 45.7%; RR 0.74 (0.72-0.77). CONCLUSION: People living in low-income and high-immigration DAs had the lowest screening participation for all tests, although disparities were highest for cancer. An organized integrated chronic disease screening strategy leveraging the higher diabetes and high cholesterol screening participation may increase screening for cancer and other chronic diseases in never- and underscreened populations. KEY WORDS: Health care disparities; early detection of cancer; dyslipidemia; diabetes OBJECTIFS : Peu d'etudes comparent les disparites socioeconomiques dans le recours aux tests de depistage du cancer et aux tests recommandes pour depister d'autres maladies chroniques. Nous avons cherche a determiner si le recours aux tests de depistage du cancer colorectal, du col uterin et du sein, ainsi que du diabete et de l'hypercholesterolemie, differe selon le niveau socioeconomique du quartier et le statut d'immigrant recent. METHODE : Nous avons mene une etude de cohortes populationnelle retrospective aupres de patients vivant en Ontario (Canada) identifies comme etant admissibles au depistage en 2009. Les codes postaux ont servi a affecter chaque resident a une aire de diffusion (AD). A l'aide des donnees du Recensement du Canada, les AD ont ete stratifiees selon le quintile de revenu et la proportion d'immigrants recents. Nous avons calcule la prevalence du depistage du cancer (colorectal, du col uterin, du sein), du diabete et de l'hypercholesterolemie a l'aide de donnees administratives, ainsi que les ratios de prevalence (moins/mieux nantis). RESULTATS : La cohorte comptait 7 652 592 personnes. La participation au depistage du cancer colorectal (femmes 61,6%; hommes 55,1%) et du cancer du sein (59,9%) etait la plus faible, et la participation au depistage du diabete (femmes 72,9%; hommes 61,4%) et de l'hypercholesterolemie (femmes 82,4%; hommes 70,3%) etait la plus elevee. Nous avons constate des disparites dans le recours a tous les tests, la participation la plus faible et les plus grandes disparites dans le depistage du cancer etant observes chez les residents des AD a faible revenu et a forte immigration : cancer colorectal--femmes 48,6%; RT 0,77; IC de 95% (0,74-0,79) et hommes 40,6%; RT 0,71 (0,68-0,74); cancer du col uterin--52,0%; RT 0,80 (0,78-0,81) et cancer du sein 45,7 %; RT 0,74 (0,72-0,77). CONCLUSIONS : Les residents des AD a faible revenu et a forte immigration affichaient la plus faible participation au depistage pour l'ensemble des tests, mais avec des disparites plus prononcees pour le depistage du cancer. Une strategie structuree et integree de depistage des maladies chroniques misant sur la participation plus elevee au depistage du diabete et de l'hypercholesterolemie pourrait accroitre le depistage du cancer et d'autres maladies chroniques dans les populations jamais ou insuffisamment depistees. MOTS CLES : disparites d'acces aux soins; depistage precoce du cancer; dyslipidemies; diabete, Screening for cancer (or cancer precursors) and other chronic diseases in asymptomatic people is intended to separate healthy persons from those who may be at sufficient increased risk of a [...]

Fluorescent microbeads hold great promise for in vivo continuous glucose monitoring with wireless transdermal transmission and long-lasting activity. The full potential of fluorescent microbeads has yet to be realized due to insufficient intensity for transdermal transmission and material toxicity. This paper illustrates the highly-sensitive, biostable, long-lasting, and injectable fluorescent microbeads for in vivo continuous glucose monitoring. We synthesized a fluorescent monomer composed of glucose-recognition sites, a fluorogenic site, spacers, and polymerization sites. The spacers are designed to be long and hydrophilic for increasing opportunities to bind glucose molecules; consequently, the fluorescent monomers enable high-intensive responsiveness to glucose. We then fabricated injectable-sized fluorescent polyacrylamide hydrogel beads with high uniformity and high throughput. We found that our fluorescent beads provide sufficient intensity to transdermally monitor glucose concentrations in vivo. The fluorescence intensity successfully traced the blood glucose concentration fluctuation, indicating our method has potential uses in highly-sensitive and minimally invasive continuous blood glucose monitoring. fluorescent hydrogel | microfluidics | diboronic acid | continuous glucose monitoring | diabetes mellitus doi/ 10.1073/pnas.1006911107

OBJECTIVE: To investigate the age-specific relationship between body mass index (BMI) and risk of diabetes in a Japanese general population. PARTICIPANTS AND METHODS: A cohort of Japanese men (N=19,926) and [...]

OBJECTIVES: To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population. PATIENTS AND METHODS: In this [...]

BACKGROUND: Increasing evidence suggests that high selenium levels are associated with diabetes and other cardiometabolic risk factors. OBJECTIVES: We evaluated the association of serum selenium concentrations with fasting plasma glucose, [...]

Objectives: Raised glycosylated haemoglobin ([HbA.sub.sup.1c]) concentration is a recognized risk factor for diabetes, the incidence of which is rising worldwide. The intake of certain foods has been related to [HbA.sub.1c] concentration. The aim of this study was to investigate whether nutrient intake, sourced by these foods, was predictive of raised glycosylated haemoglobin ([HbA.sub.sup.1c]) concentration in a British cohort. Subjects: The subjects were 495 men and 570 women who were members of the Medical Research Council National Survey of Health and Development, 1946 birth cohort. Diet was assessed from 5-day records in 1982, 1989 and 1999. [HbA.sub.1c] was measured in blood samples collected in 1999. Individuals in whom concentration of [HbA.sub.1c] was [greater than or equal to] 6.3% were identified as being 'at risk' and their nutrient intake was compared with those whose concentration of [HbA.sub.1c] was within the normal range ([less than or equal to] 6.2%). Results: Lower intakes of protein, carbohydrate, non-starch polysaccharide, iron, folate, vitamin [B.sub.12] and a higher percentage energy from fat in 1989 were significantly predictive of high [HbA.sub.1c] status in 1999. In 1999, there were no nutrient intakes that were predictive of [HbA.sub.1c] status. Global tests of whether the intakes of energy, carbohydrate, sodium, iron, riboflavin and vitamin [B.sub.12] at all three time points were related to [HbA.sub.1c] status in 1999, were significant. Conclusion: An increased intake of energy, carbohydrate, sodium, iron, riboflavin and vitamin [B.sub.12] over 10 years was predictive of raised [HbA.sub.1c] status. Increased energy intake may have resulted in increase in body weight, which is a risk factor for diabetes. doi:10.1038/ejcn.2009.43; published online 24 June 2009 Keywords: diet; nutrients; glycosylated haemoglobin; NSHD, Introduction Elevated glycosylated haemoglobin ([HbA.sub.1c]) in the blood is an indicator of chronically raised blood glucose concentrations, which is used as a method of identifying people at risk of developing [...]

Objective: To compare changes in diagnosed diabetes prevalence and incidence among Status Aboriginal men and women living in urban and rural areas of Alberta. Methods: We compared trends in diabetes prevalence and incidence from 1995 to 2006 based on diagnostic codes from Alberta Health and Wellness (AHW) administrative records for adults aged 20 years and older. The AHW Registry file was used to determine registered Aboriginal status, as well as rural and urban residence (based on postal code). Multivariable logistic regression was used to compare diabetes rates over time, by sex and location of residence. Results: Age- and sex-adjusted diabetes prevalence increased 35% in rural Status Aboriginals, from 10.9 (10.4-11.5) per 100 in 1995 to 14.7 (14.215.2) per 100 in 2006. Rates in urban Status Aboriginals increased 22% in the same time period from 9.4 (8.5-10.3) per 100 in 1995 to 11.5 (10.912.1) per 100 in 2006. The increases in prevalence were greater (p Conclusions: Prevalence and incidence of diagnosed diabetes were highest in Status Aboriginal women, but these rates have increased faster in men over the past decade, regardless of their location of residence. Key words: Diabetes; epidemiology; rural health; Status Aboriginal Objectif : Comparer les changements de taux de prevalence et d'incidence du diabete diagnostique chez les hommes et les femmes qui appartiennent a la population autochtone et qui resident dans les regions urbaines et rurales de l'Alberta. Methodes : Nous avons compare les tendances des taux de prevalence et d'incidence du diabete de 1995 a 2006, selon les codes de diagnostic des dossiers administratifs conserves par Alberta Health and Wellness (AHW) pour les adultes fges de 20 ans ou plus. Les fichiers du registre d'AHW ont ete utilises pour determiner le statut de personne inscrite comme Autochtone, en plus de sa residence rurale ou urbaine (selon le code postal). Une analyse de regression logistique multidimensionnelle a ete utilisee pour comparer les taux de diabete au fil des ans, selon le sexe et le lieu de residence. Resultats : Le taux de prevalence du diabete, rajuste pour tenir compte de l'fge et du sexe, a augmente de 35 % chez les Autochtones qui resident en milieu rural, de 10,9 (10,4 a 11,5) par 100 habitants en 1995 a 14,7 (14,2 a 15,2) par 100 habitants en 2006. Le taux de prevalence du diabete chez les Autochtones qui resident en milieu urbain a augmente de 22 % au cours de la meme periode, de 9,4 (8,5 a 10,3) par 100 habitants en 1995 a 11,5 (10,9 a 12,1) par 100 habitants en 2006. Les augmentations des taux de prevalence (p Conclusions : Les taux de prevalence et d'incidence du diabete diagnostique etaient plus eleves chez les femmes autochtones, mais ces taux ont augmente plus rapidement chez les hommes autochtones au cours de la derniere decennie, peu importe le lieu de residence. Mots cles : diabete; epidemiologie; sante en milieu rural; personne appartenant a la population autochtone, Aboriginal Canadians, including First Nations, Metis and Inuit people, are recognized to be at increased risk for major health problems.1 The increasing prevalence and incidence of diabetes mellitus among Aboriginal [...]

Multiclass Mahalanobis-Taguchi system (MMTS), the extension of MTS, is developed for simultaneous multiclass classification and feature selection. In MMTS, the multiclass measurement scale is constructed by establishing an individual Mahalanobis space for each class. To increase the validity of the measurement scale, the Gram-Schmidt process is performed to mutually orthogonalize the features and eliminate the multicollinearity. The important features are identified using the orthogonal arrays and the signal-to-noise ratio, and are then used to construct a reduced model measurement scale. The contribution of each important feature to classification is also derived according to the effect gain to develop a weighted Mahalanobis distance which is finally used as the distance metric for the classification of MMTS. Using the reduced model measurement scale, an unknown example will be classified into the class with minimum weighted Mahalanobis distance considering only the important features. For evaluating the effectiveness of MMTS, a numerical experiment is implemented, and the results show that MMTS outperforms other well-known algorithms not only on classification accuracy but also on feature selection efficiency. Finally, a real case about gestational diabetes mellitus is studied, and the results indicate the practicality of MMTS in real-world applications. Index Terms--Classification, feature selection, multiclass problem, Mahalanobis-Taguchi system (MTS), weighted Mahalanobis distance, Gram-Schmidt orthogonalization process, gestational diabetes mellitus.

Diabetic kidney disease (DKD) occurs in 20% to 40% of patients with diabetes mellitus and is the leading cause of chronic kidney disease and end-stage renal disease in the United [...]

The advent of hyperpolarized [sup.13]C magnetic resonance (MR) has provided new potential for the real-time visualization of in vivo metabolic processes. The aim of this work was to use hyperpolarized [1-[sup.13]C]pyruvate as a metabolic tracer to assess noninvasively the flux through the mitochondrial enzyme complex pyruvate dehydrogenase (PDH) in the rat heart, by measuring the production of bicarbonate ([H.sup.13]C[O.sup.-.sub.3]), a byproduct of the PDH-catalyzed conversion of [1-[sup.13]C]pyruvate to acetyl-CoA. By noninvasively observing a 74% decrease in [H.sup.13]C[O.sup.-.sub.3] production in fasted rats compared with fed controls, we have demonstrated that hyperpolarized [sup.13]C MR is sensitive to physiological perturbations in PDH flux. Further, we evaluated the ability of the hyperpolarized [sup.13]C MR technique to monitor disease progression by examining PDH flux before and 5 days after streptozotocin induction of type 1 diabetes. We detected decreased [H.sup.13]C[O.sup.-.sub.3] production with the onset of diabetes that correlated with disease severity. These observations were supported by in vitro investigations of PDH activity as reported in the literature and provided evidence that flux through the PDH enzyme complex can be monitored noninvasively, in vivo, by using hyperpolarized [sup.13]C MR. cardiac metabolism | diabetes | fasting | DNP

We report 10 heterozygous mutations in the human insulin gene in 16 probands with neonatal diabetes. A combination of linkage and a candidate gene approach in a family with four diabetic members led to the identification of the initial INS gene mutation. The mutations are inherited in an autosomal dominant manner in this and two other small families whereas the mutations in the other 13 patients are de novo. Diabetes presented in probands at a median age of 9 weeks, usually with diabetic ketoacidosis or marked hyperglycemia, was not associated with [beta] cell autoantibodies, and was treated from diagnosis with insulin. The mutations are in critical regions of the preproinsulin molecule, and we predict that they prevent normal folding and progression of proinsulin in the insulin secretory pathway. The abnormally folded proinsulin molecule may induce the unfolded protein response and undergo degradation in the endoplasmic reticulum, leading to severe endoplasmic reticulum stress and potentially [beta] cell death by apoptosis. This process has been described in both the Akita and Munich mouse models that have dominant-acting missense mutations in the Ins2 gene, leading to loss of [beta] cell function and mass. One of the human mutations we report here is identical to that in the Akita mouse. The identification of insulin mutations as a cause of neonatal diabetes will facilitate the diagnosis and possibly, in time, treatment of this disorder. endoplasmic reticulum stress | insulin biosynthesis | disulfide bonds | unfolded protein response

This paper investigates levels in diabetes prevalence patterns across key socioeconomic status indicators and how they changed over time. The investigation spans both the conventional concept of diagnosed diabetes and a more comprehensive measure that includes those whose diabetes is undiagnosed. By doing so, I separate the distinct impact of covariates on trends over time in disease onset and the probability of disease diagnosis. The principal force leading to higher diabetes prevalence over time is excessive weight and obesity, which was only partially offset by improvements in the education of the population over time. Undiagnosed diabetes remains an important health problem, but much less so than 25 years ago. Although race and ethnic differentials in undiagnosed diabetes were eliminated over the last 25 years, the disparities became larger across other measures of disadvantage, such as education. diagnosed

Objective: To investigate patterns of membership and barriers to service use in the Christchurch Diabetes Society. Methods: A socio-economic profile of the Christchurch Diabetes Society's membership was constructed by examining the residential locations of society members in Christchurch City. Rates of membership by deprivation decile were calculated by comparing the membership data to the population of people diagnosed with diabetes. Results: Persons living in deprived areas, in particular Maori and Pacific people, are under-represented in society membership. However, there is evidence that the relationship between ethnicity and membership rates is stronger in more deprived areas. Conclusions: This study provides further insights in understanding barriers to care and the role of NGOs. Given that groups in the community most likely to be affected by diabetes are least likely to be members of the society and to have access to the society's services, the results raise questions about the most appropriate role for local diabetes societies within a decentralised health system.

Diffuse photon density wave (DPDW) methodology at Near Infrared frequencies has been used to calculate absorption and scattering from wounds of healthy and diabetic rats. The diffusion equation for senti-infinite media is being used for calculating the absorption and scattering coefficients based on measurements of phase and amplitude with a frequency domain device. Differences observed during the course of healing in the two populations can be correlated to the delayed healing observed in diabetics. These results are encouraging and further work will focus on the implementation of this device to the clinical setting as a monitoring tool in chronic diabetic wounds. Index Terms--Diabetic wounds, diffuse photon density wave, near infrared spectroscopy (NIRS).

Several studies have shown that patients suffering from Diabetes Mellitus can significantly delay the onset and slow down the progression of diabetes micro-and macro-angiopathic complications through intensive monitoring and treatment. In general, intensive treatments imply a careful blood glucose level (BGL) self-monitoring. The analysis of BGL measurements is one of the most important tasks in order to assess the glucose metabolic control and to revise the therapeutic protocol. Recent clinical studies have shown the correlation between the glucose variability and the long-term diabetes related complications. In this paper, we propose a stochastic model to extract the time course of such variability from the self-monitoring BGL time series. This information can be conveniently combined with other analysis to evaluate the adequacy of the therapeutic protocol and to highlight periods characterized by an increasing glucose instability. The method here proposed has been validated on two simulated data sets and tested with success in the retrospective analysis of three patients' data sets. Index Terms--Bayesian estimation, blood glucose level time series analysis, blood glucose variability, diabetes long-term complications, diabetic patients home monitoring, Markov chain Monte Carlo methods, risk index, stochastic volatility models.

Objective: To evaluate for Indigenous Australians the agreement between a fasting plasma glucose (FPG) criterion of 7.0 mmol/L and diabetes test results using a two-hour oral glucose tolerance test (OGTT), comparing relationships between test agreement and prevalence to similar studies. Methods: Screening was undertaken in 25 remote settlements. Agreement between FPG and OGTT results was evaluated using the kappa coefficient (chance-corrected agreement). Results: Participants (n=3,249) ranged from 15-94 years. Kappa ranged from 0.70-0.77 for diabetes prevalence of 5-30%, with overall agreement of 0.76. In comparison studies, the relationship between kappa and diabetes prevalence was similar, but with kappa 0.21-0.48. Conclusions and Implications: A FPG test with a 7.0 mmol/L cut-off is a reliable screening method, relative to the OGTT, for remote Indigenous settlements. The level of agreement between the FPG test and the OGTT for the Indigenous population surveyed is superior by far to agreement reported for non-Indigenous samples.

A study is done to examine the relationship between HIV-associated dementia (HAD) and diabetes among patients with HIV-1 infection. Within the Hawaii aging with HIV cohort, a longitudinal study enriched with older HIV-1-infected individuals, concluded that diabetes is associated with prevalent dementia.

With the growing number of individuals having diabetes, it is likely that most dental practitioners will see patients with this disease more frequently. Therefore, it is not unlikely that in [...]

Background and Objectives: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth. Methods: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow-up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non-consecutive days to determine screening, follow-up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer. Result: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow-up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow-up meant that the sensitivity, specificity and cost-effectiveness of the test could not be assessed. Conclusions and Implications: The reasons for poor follow-up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.

Screening guidelines proposed by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus have been endorsed by several medical societies. However, one-third of cases are undiagnosed, and complications at the time of diagnosis indicate that disease may have been present for several years before diagnosis. This study evaluates the effectiveness of the guidelines for detecting new cases of diabetes mellitus. By using a cross-sectional, representative sample of the United States (National Health and Nutritional Examination Survey, NHANES III), the guidelines are tested on adults, 20 years and older without a prior diagnosis of diabetes. Individuals are classified as nondiabetics (n = 6,241) or as having undiagnosed diabetes (n = 274) based on their blood glucose. Screening when one risk factor is present, as stated in the guidelines, has a true-positive rate of 100% and would require that 83% of the population be tested. Screening when two risk factors are present is more efficient, with a comparable true-positive rate (98%), but requires that only 59% of the population be tested. A notable finding is the earlier age of onset among minorities, which may be associated with other health disparities. Because diabetes occurs at younger ages in minorities, screening whites who are [greater than or equal to]40 and minorities [greater than or equal to]30 years of age has a high true-positive rate (95%) and also reduces testing (60%). The screening guidelines would be effective, if followed, and would essentially eliminate undiagnosed cases of diabetes.