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Single-Sample Confirmatory Testing for Diabetes

Ann Intern Med; ePub 2018 Jun 19; Selvin, et al

A single-sample confirmatory definition of diabetes had a high positive predictive value for subsequent diagnosis and was strongly associated with clinical end points, a recent study found. 13,346 participants from the Atherosclerosis Risk in Communities (ARIC) study (12,268 without diagnosed diabetes) were included with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease, and mortality. Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose and HbA1c from a single blood sample. Researchers found:

  • Among 12,268 participants without diagnosed diabetes, 978 had elevated levels of fasting glucose or HbA1c at baseline.
  • Among these, 39% had both (confirmed undiagnosed diabetes), whereas 61% had only 1 elevated measure (unconfirmed undiagnosed diabetes).
  • The confirmatory definition had moderate sensitivity (54.9%) but high specificity (98.1%) for identification of diabetes cases diagnosed during the first 5 years of follow-up, with specificity increasing to 99.6% by 15 years.
  • 15-year positive predictive value was 88.7% vs 71.1% for unconfirmed cases.
  • Confirmed undiagnosed diabetes was significantly associated with CV and kidney disease and mortality, with stronger associations than unconfirmed diabetes.
Citation:

Selvin E, Wang D, Matsushita K, Grams ME, Coresh J. Prognostic implications of single-sample confirmatory testing for undiagnosed diabetes: A prospective cohort study. [Published online ahead of print June 19, 2018]. Ann Intern Med. doi:10.7326/M18-0091.

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