Table 4.
Relative performance of different population screening strategies: number of individuals invited to screening for risk of diabetes, the incidence of diabetes over 3 years, sensitivity, specificity and the area under the receiver operating characteristic curve for prediction of incident diabetes
| Number of individuals invited to screening (%) | Incident cases of diabetes in risk group* (%) | Incidence of diabetes over 3 years, % (95% CI) in those invited | Sensitivity (95% CI) for prediction of incident diabetes over 3 years | Specificity (95% CI) for prediction of incident diabetes over 3 years | Area under the receiver operating characteristic curve (95% CI) for prediction of incident diabetes over 3 years | |
|---|---|---|---|---|---|---|
| Prestratification followed by HbA1c 42–48 mmol/mol (6.0–6.4%) | ||||||
| Strategy 1: all individuals | 5910 (100) | 77 (100) | 1.33 (1.04–1.63) | 0.38 (0.27–0.49) | 0.94 (0.93–0.94) | 0.66 (0.60–0.71) |
| Strategy 2: age ≥ 50 years | 4443 (75) | 68 (88) | 1.57 (1.20–1.94) | 0.36 (0.26–0.48) | 0.94 (0.94–0.95) | 0.65 (0.60–0.71) |
| Strategy 3: age ≥ 50 years AND overweight† | 2977 (50) | 57 (74) | 1.98 (1.47–2.49) | 0.32 (0.22–0.44) | 0.96 (0.95–0.97) | 0.64 (0.59–0.70) |
| Strategy 4: age ≥45 years AND one or more of risk factor for diabetes‡ | 1868 (32) | 42 (55) | 2.34 (1.64–3.03) | 0.23 (0.15–0.35) | 0.97 (0.97–0.98) | 0.60 (0.56–0.65) |
| Strategy 5: CRS ≥ 0.15 | 2361 (40) | 49 (64) | 2.16 (1.56–2.76) | 0.27 (0.18–0.39) | 0.96 (0.96–0.97) | 0.62 (0.57–0.67) |
| Strategy 6: FINDRISC ≥ 9 | 2453 (42) | 49 (64) | 2.07 (1.50–2.65) | 0.29 (0.19–0.40) | 0.97 (0.96–0.97) | 0.63 (0.57–0.68) |
| Prestratification followed by HbA1c 37–48 mmol/mol (5.5–6.4%) | ||||||
| Strategy 7: age ≥50 years AND overweight | 2977 (50) | 57 (74) | 1.98 (1.47–2.49) | 0.57 (0.45–0.68) | 0.82 (0.81–0.83) | 0.69 (0.64–0.75) |
| Strategy 8: age ≥45 years AND one or more of risk factor for diabetes | 1868 (32) | 42 (55) | 2.34 (1.64–3.03) | 0.44 (0.33–0.56) | 0.89 (0.88–0.90) | 0.66 (0.61–0.72) |
| Strategy 9: CRS ≥ 0.15 | 2361 (40) | 49 (64) | 2.16 (1.56–2.76) | 0.51 (0.39–0.62) | 0.85 (0.84–0.86) | 0.68 (0.62–0.73) |
| Single-step screening without blood tests | ||||||
| Strategy 10: overweight AND antihypertensive drugs | N/A | 16 (21) | 2.56 (1.32–3.80) | 0.21 (0.13–0.32) | 0.89 (0.89–0.90) | 0.55 (0.50–0.60) |
| Strategy 11: age ≥45 years AND one or more of risk factor for diabetes | N/A | 42 (55) | 2.34 (1.64–3.03) | 0.55 (0.43–0.66) | 0.69 (0.68–0.70) | 0.62 (0.56–0.68) |
| Strategy 12: CRS ≥ 0.50 | N/A | 18 (23) | 3.27 (1.78–4.76) | 0.23 (0.15–0.35) | 0.91 (0.90–0.91) | 0.57 (0.52–0.62) |
CRS, Cambridge diabetes risk score; FINDRISC, Finnish diabetes risk score; N/A, not applicable.
*
Risk group refers to individuals free of diabetes (i.e. 5788 individuals for Strategy 1). †Overweight: BMI ≥ 25 kg/m2 or waist circumference ≥ 94 cm in men and ≥ 80 cm in women. ‡Risk factors include BMI of ≥ 30 kg/m2, family history of diabetes and the use of antihypertensive drugs