Epidemic of Impaired Fasting Glycemia: Is it Real and What Do We Do?

Monday June 13, 2005
ADA Symposium
Supported by an unrestricted educational grant from GlaxoSmithKline

Faculty
Jacqueline Dekker, PhD
William Herman, MD, MPH
Frank Vinicor, MD, MPH

Reported by Joelle Escoffery, PhD

As the incidence of diabetes continues to rise, more emphasis is being placed on determining the most appropriate screening strategy. In order for screening to be effective, several conditions should be met. Specifically, the condition being screened for should have a detectable preclinical period, a well understood natural history, an effective treatment, and improved outcomes if treated earlier. Type 2 diabetes clearly meets the criteria. The screening test should be inexpensive, acceptable, valid. However, the most appropriate way of screening for type 2 diabetes is a topic of considerable interest.

A recent study demonstrated that 69% of participants were screened during a 3-year period. Further, screening was done in a manner appropriate to age, race, and risk factors. However, the methods of testing used may not represent the most appropriate way to screen for type 2 diabetes, with 95% of subjects screened with a random glucose test and not appropriately followed-up with a diagnostic test if the result was abnormal. Appropriate screening is important because we have viable strategies for delaying the onset and reducing the incidence of type 2 diabetes. Although economic analyses indicate that the cost of preventing diabetes is enormous, it still represents good value for the money spent if the most appropriate screening tests are used. From a public health perspective, there is no clear evidence suggesting that screening for impaired fasting glucose (IFG) will have a measurable effect on either diabetes or cardiovascular outcomes if screening is done in the general population. Rather, a more valid strategy may be to use IFG to screen because of its convenience, but follow up with more definitive tests such as the OGTT, as impaired glucose tolerance is a much stronger predictor of diabetes and cardiovascular disease.