MELBOURNE – Approximately half of adults who meet the eligibility for glucose testing according to four different guidelines are not being tested for type 2 diabetes, according to data from a large survey of U.S. adults.
Researchers from the Centers for Disease Control and Prevention analyzed data from 3,623 adults without diabetes who participated in the 2007-2010 National Health and Nutrition Examination Survey (NHANES).
They then used four screening and glucose testing guidelines to identify the proportion of adults who met the criteria for glucose testing, and compare this with subjects’ self-reports of glucose testing.
According to data presented at the World Diabetes Congress, the percentage of adults found eligible for glucose testing varied from 36% with the U.S. Preventive Services Task Force (USPSTF) guidelines to 80% using the U.K. National Institute for Health and Clinical Excellence (NICE) guidelines.
Dr. Giuseppina Imperatore
The other guidelines examined were the American Diabetes Association (ADA) guidelines, which found 74% were eligible, and the International Diabetes Federation/U.S. National Diabetes Prevention Program (IDF) risk test, which found 43% were eligible.
However, when researchers then examined whether eligible individuals had in fact received glucose testing, they found that approximately half did not recall being tested.
"Of those eligible according to the ADA, USPSTF, IDF, and NICE guidelines, 49.1%, 57.7%, 55.2%, and 48.9%, respectively, reported receiving a glucose test within the past 3 years," according to Dr. Giuseppina Imperatore.
Dr. Imperatore said she was surprised by the significant gap in testing practices.
"You have to take this with caution because maybe there is a recall bias, but definitely, if this is the case, it is a concern because these people should be receiving treatment or they should be receiving lifestyle modification," said Dr. Imperatore of the division of diabetes translation, CDC.
NHANES involves a questionnaire and an at-home interview and assessment, including the taking of a blood sample, which enabled the researchers to measure individuals’ blood glucose levels.
Dr. Imperatore said one of the reasons why some individuals may not have been tested was their health insurance status.
"When we looked at the percentage of tested and nontested in terms of health care insurance, those that were not tested were more likely not to have health insurance, so this is probably one of the reasons they didn’t get tested, although they were at high risk for diabetes or prediabetes," Dr. Imperatore said in an interview.
The study also found a wide range of sensitivities and specificities across the guidelines. The NICE guidelines were the most sensitive at 92% but had the lowest specificity at 31%, while the U.S. Preventive Services Task Force guidelines had the highest specificity (83%) but lowest sensitivity (31%).
Dr. Imperatore said she would opt for the American Diabetes Association guidelines, which had the highest sensitivity of the U.S. guidelines.
There were no conflicts of interest reported.