Screening for people at risk of type 2 diabetes: Current situation - - PowerPoint PPT Presentation

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Screening for people at risk of type 2 diabetes: Current situation - - PowerPoint PPT Presentation

Jun 15, 2023 173 likes •575 views

Screening for people at risk of type 2 diabetes: Current situation and future challenges Nol C. Barengo, MD, PhD, MPH Herbert Wertheim College of Medicine Florida International University E-mail: nbarengo@fiu.edu

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Screening for people at risk of type 2 diabetes: Current situation and future challenges

Noël C. Barengo, MD, PhD, MPH Herbert Wertheim College of Medicine Florida International University E-mail: nbarengo@fiu.edu https://www.facebook.com/NoelCBarengo/

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Content

I. Introduction

  • II. Why to screen for people at a high risk for T2D?
  • III. How to screen for people with type 2 diabetes?
  • IV. Unsolved questions and challenges
  • V. Conclusions and recommendations
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  • I. Introduction
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7.0 8.0 9.0 10.0 11.0 12.0 5.0 5.5 6.0 6.5 7.0 7.5

NG IGT IFG

Type 2 diabetes

7.8-11.0 mmol / l <7.8 mmol / l

Fasting Glucose, mmol / l 2-h glucose, mmol / l

4.3% / year 4.0% / year 7.0% / year

IGT+ IFG

The development of type 2 diabetes

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Modifiable type 2 diabetes risk factors

  • Obesity / weight gain
  • Central obesity
  • Physical inactivity
  • Sitting time
  • Smoking
  • Gestational Diabetes
  • Pre-eclamsia
  • Very low birth weight
  • Fatty liver
  • Depression
  • Anti-psychotic drugs
  • Poor sleep
  • Hypertension
  • Statins
  • Dietary Factors (risk increase or

decrease) – Carbohydrate quality – Fat quality – Glycemic index – Whole grain / cereal fibers – Low-fat dairy products – Alcohol – Coffee – Fast food intake – Sweet beverages – Magnesium

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  • II. Why screen for people at a high risk for

T2D?

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Lindström et al. Lancet 2006.

Diabetes Prevention Study

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Diabetes Prevention Program

W Knowler, et al. N Engl J Med 2002; 346: 393-403.

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Summary of intervention trials in people with prediabetes

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CDC Diabetes Prevention Recognition Program

  • 1557 CDC-recognized programs across 50 states/territories.
  • >10,300 coaches (lay people; health professionals) trained.
  • Serving 156,935 eligible participants.
  • 65 commercial health plans providing some coverage for 3M in 11 states
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Diabetes Prevention in the Real World

Dunkley et al. Diabetes Care 2014

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  • III. How to screen for people with type 2

diabetes?

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Identify and treat those beyond a threshold for risk factor Shift the whole population distribution of risk factor lower

High risk approach Population approach

Risk factor distribution Risk factor distribution

Disease prevention approaches

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High risk strategy

  • Identification of people at high risk of type 2 diabetes

(screening)

  • Intervention targeting people at high risk of type 2 diabetes
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Measurement of blood glucose – OGTT – Fasting glucose – HbA1C – Capillary glucose IDENTIFY PEOPLE AT HIGH-RISK OF DT2 LATE Questionnaires (risk scales) of lifestyle and risk factors for diabetes IDENTIFY PEOPLE AT HIGH-RISK OF DT2 EARLY

Strategies for detecting DT2 and hyperglycemia

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Objectives of screening

  • What is the probability that people with a

positive test have diabetes?

  • Is the test is a good predictor for future

diabetes?

  • Can the test identify people at low risk?
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Screening vs diagnosis

 A screening test is not diagnostic  Screening tests are cheaper than diagnostic tests  A positive screening test needs confirmation through a diagnostic test

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The concept is developing a screening tool that ... ... is simple, economical and reliable to identify people at high risk for type 2 diabetes. ... can be applied easily in the general population. ... does not require blood extractions or other measures that require special equipment or trained personnel.

The objective of FINDRISC

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FINnish Diabetes RIsk SCore

Score range 0-26 p

Lindström & Tuomilehto Diabetes Care 2003; 26: 725-731

  • No laboratory tests
  • No specially trained

personnel needed

  • No special equipments
  • Inexpensive, easy, fast
  • Accurate
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0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 False positive rate True positive rate

Cut off point: >10

Sensitivity = 0.73 Specificity = 0.83 Positive predictive value= 0.16 Negative predictive value= 0.99 AUC = 0.85

The ROC curve of the FINDRISC

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Gray L.J, Khunti K, Taub NA, Hiles S, Davies MJ (2009) Oral presentation 20th World Diabetes Congress, Montreal, October 2009

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  • 1. Edad

Puntaje Menos de 45 años 45 a 54 años 1 55 a 64 años 2 Más de 64 años 3

  • 4. Perímetro abdominal*

*Ver instrucciones de medición en cara 2

Puntaje Hombres Mujeres Menos de 94 cm. Menos de 90 cm. 94 cm. o más 90 cm. o más 2

  • 3. Toma medicamentos para el tratamiento de la hipertensión arterial

Puntaje No Si 2

  • 2. Tiene antecedente de padres o hermanos con diagnóstico de diabetes

mellitus Puntaje No Si 2

Puntos por edad Puntos por diabetes en familiar de primer grado Puntos por medicamentos para hipertensión arterial Puntos por perímetro abdominal

PUNTAJE TOTAL

Sume los puntos de cada pregunta. Si el puntaje total es mayor o igual a 4, indique una prueba de tolerancia a la glucosa dado que, la persona tiene 5 veces más posibilidades de tener diabetes mellitus en comparación con aquellos sujetos con menos de 4 puntos.

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ROC for original FINDRISC Area under the curve: 0.71; 95% CI 0.68-0.74 ROC for SADRISC Area under the curve: 0.76; 95% CI 0.73-0.79

Receiver operating characteristics (ROC) curves for the prevalence of abnormal glucose tolerance for the SADRISC (Saudi Arabian Diabetes Risk Score) and the original FINDRISC.

Barengo et al. Unpublished data. 2019

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Are there differences in risk factors for type 2 diabetes among different populations?

NO! But the relative contribution (weight) may vary between populations.

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FINDRISC distributed (n=14 193) FINDRISC ≥ 13 (n=4915) No OGTT (n=2611) OGTT (n=2304) Normoglycemic 59% (n=1347) IFG 11% (n=263) IGT 9% (n=204) IFG and IGT combined 8% (n=184) Screen detected T2D 13% (n=306) FINDRISC < 13 (n=9278)

Barengo et al Diabetes Metab Res Rev. 2013

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  • IV. Unsolved questions and challenges
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Which diagnostic test to use?

Which invasive diagnostic test to use after screening (fasting glucose, HbA1C, 2-hour glucose, 1-hour glucose, capillary glucose)?

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Optimal time interval

What is the optimal time interval between screening activities?

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Changing lifestyle

Are people diagnosed as being at a high risk of T2D more likely to change their lifestyle than people who are unaware of their risk

  • r whether a negative test may have an adverse shift in health

behaviors?

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Long term benefits

Information on long-term benefits of T2D screening programs?

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Impact

Short or long-term impact

  • f T2D screening

programs?

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Attendance

Attendance for diagnostic tests after positive screening test?

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FINDRISC distributed (n=14 193) FINDRISC ≥ 13 (n=4915) No OGTT (n=2611) OGTT (n=2304) Normoglycemic 59% (n=1347) IFG 11% (n=263) IGT 9% (n=204) IFG and IGT combined 8% (n=184) Screen detected T2D 13% (n=306) FINDRISC < 13 (n=9278)

Barengo et al Diabetes Metab Res Rev. 2013

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  • V. Conclusions and

recomendations

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Conclusions (II)

  • Validated screening tests exist
  • Screening tests have been successfully implemented in

various countries and institutions

  • Main challenges include among others monitoring

attendance , short- and long term benefits, implementation

  • f guidelines and time interval of screening tests.
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Knowledge integration process

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Thank you

http://www.facebook.com/NoelCBarengo E-mail: nbarengo@fiu.edu