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Identification of Persons at High Risk for Type 2 Diabetes Mellitus: Do We Need the Oral Glucose Tolerance Test?
- Michael P. Stern, MD;
- Ken Williams, MS; and
- Steven M. Haffner, MD, MPH
Abstract
Background: The standard method of identifying persons at high risk for type 2 diabetes mellitus involves detection of impaired glucose tolerance, which requires a costly and inconvenient 2-hour oral glucose tolerance test. Because clinical trials have indicated that diabetes is preventable by using behavioral or pharmacologic interventions, less expensive methods of identifying high-risk persons are needed.
Objective: To determine whether multivariable models are superior to glucose tolerance tests for identifying persons at high risk for diabetes mellitus.
Design: Prospective cohort study.
Setting: San Antonio, Texas.
Participants: 1791 Mexican Americans and 1112 non-Hispanic whites without diabetes at baseline who were randomly selected from census tracts.
Measurements: Medical history; body mass index; blood pressure; fasting and 2-hour plasma glucose levels; fasting serum total, low-density lipoprotein, and high-density lipoprotein cholesterol levels; and triglyceride level.
Results: For prediction of 7.5-year incidence of type 2 diabetes, the area under the receiver-operating characteristic (ROC) curve for a multivariable model involving readily available clinical variables was significantly (P < 0.001) greater than the area under the ROC curve for the 2-hour glucose value alone (84.3% vs. 77.5%). Impaired glucose tolerance represents a single point on the latter curve. Adding the 2-hour glucose measurement to the multivariable model increased the area under its ROC curve, but only from 84.3% to 85.7%.
Conclusion: Persons at high risk for diabetes mellitus are better identified by using a simple prediction model than by relying exclusively on the results of a 2-hour oral glucose tolerance test. Although adding the 2-hour glucose variable to the model enhanced prediction, the resulting slight improvement entails greater cost and inconvenience.
Article and Author Information
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Acknowledgment: The authors thank Dr. Agustin Escalante for providing helpful advice on the evaluation of ROC curves.
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Grant Support: By the National Heart, Lung, and Blood Institute (grants RO1 HL24799 and RO1 HL36820).
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Requests for Single Reprints: Michael P. Stern, MD, Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900; e-mail, stern{at}uthscsa.edu.
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Current Author Addresses: Drs. Stern and Haffner and Mr. Williams: Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.
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Author Contributions: Conception and design: M.P. Stern, S.M. Haffner.
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Analysis and interpretation of the data: M.P. Stern, K. Williams, S.M. Haffner.
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Drafting of the article: M.P. Stern, K. Williams.
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Critical revision of the article for important intellectual content: M.P. Stern, K. Williams, S.M. Haffner.
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Final approval of the article: M.P. Stern, K. Williams, S.M. Haffner.
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Statistical expertise: K. Williams.
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Obtaining of funding: M.P. Stern.
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Administrative, technical, or logistic support: M.P. Stern.
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Collection and assembly of data: M.P. Stern, S.M. Haffner.
- Copyright ©2004 by the American College of Physicians
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