Screening for IGT: Glucose Challenge vs Predictive Model

描述(由申请人提供)： NIDDK和美国糖尿病协会建议对“糖尿病前期”进行常规筛查--这是一个主要的公共健康问题--但我们不知道如何最好地发现它。在美国，2型糖尿病及其前驱疾病“糖尿病前期”(主要是糖耐量受损，IGT)的发病率正在急剧上升。糖尿病预防计划的结果显示，从IGT到糖尿病的进展可以减少，但只有在患者得到认可的情况下，他们才能被引导到降低风险的计划中；检测IGT对非裔美国人等少数群体尤其重要，他们患有糖尿病的比例更高。然而，由于我们不筛查IGT，许多IGT患者进展为糖尿病，当他们最终被诊断时，他们已经有并发症和心血管风险增加。基于风险因素的“预测模型”可能会确定哪些人应该进行OGTT来检测IGT，但这种方法的适用性可能有限，通常不用于筛查妊娠期糖尿病，因为妊娠期糖尿病的代谢缺陷类似于IGT。假设：通过一小时口服葡萄糖挑战试验(GCT)进行两步筛查，如果异常，然后进行OGTT，将具有良好的预测能力来识别IGT，在诊断效率和成本效益方面都优于“预测模型”。具体目标：(1)为了验证GCT作为IGT的可靠预测因子，我们将在大量非裔美国人和高加索人中进行GCT和OGTT，目的有两个：(A)确定在两组中提供最佳测试特征的临界水平，尽管膳食状况或一天中的时间不同；(B)确定潜在危险因素(年龄、种族、家族史、BMI、腰臀比、血脂异常、高血压等)如何改变预测能力；(2)为了比较GCT筛查和“预测模型”筛查，我们将评估预测能力和成本-效果。要实现DPP的潜力，需要一种高度可推广、低成本的筛查策略；我们的多学科团队将把已证明对妊娠期糖尿病有益的方法转化为一种经济高效的方法，以确定哪些人可以从减少IGT进展到糖尿病并降低心血管风险的计划中受益。足够快地开始管理是糖尿病护理中的一个主要问题--特别是对健康方面存在差异的少数族裔。通过将现有知识应用于疾病控制和预防，我们的具体目标是解决这一问题的关键第一步。

DESCRIPTION (provided by applicant): NIDDK and the American Diabetes Association have recommended routine screening for "pre-diabetes" - a major public health problem - but we do not know how best to detect it. The U.S. is experiencing a dramatic rise in both type 2 diabetes and its antecedent, "pre-diabetes" (mostly impaired glucose tolerance, IGT). Diabetes Prevention Program results show that progression from IGT to diabetes can be decreased, but patients can only be directed to risk reduction programs if they are recognized; detecting IGT will be especially important for minority populations such as African-Americans, who suffer disproportionately from diabetes. However, since we don't screen for IGT, many IGT patients progress to diabetes, and already have complications and increased cardiovascular risk when they are finally diagnosed. Risk factor-based "predictive models" might identify individuals who should have an OGTT to detect IGT, but such approaches may have limited applicability, and are generally not used to screen for gestational diabetes, where the metabolic defect is similar to IGT. Hypotheses: Two-step screening by a one hour oral glucose challenge test (GCT) followed, if abnormal, by an OGTT will have good predictive ability to identify IGT, and will be superior to "predictive models" in both diagnostic efficiency and cost-effectiveness. Specific Aims: (1) To validate the GCT as a reliable predictor of IGT, we will perform both the GCT and an OGTT in a large number of African-Americans and Caucasians, with two objectives: (a) to identify cutoff levels which provide optimal test characteristics in both groups despite variation in prandial status or time of day; (b) to determine how predictive ability is modified by the presence of potential risk factors (age, ethnicity, family history, BMI, waist-hip ratio, dyslipidemia, hypertension, etc.); (2) To compare GCT screening to "predictive model" screening, we will evaluate both predictive ability and cost-effectiveness. Fulfilling the potential of the DPP demands a highly generalizable, low-cost screening strategy; our multidisciplinary team will translate approaches proven beneficial for gestational diabetes into a cost-effective method to identify individuals who could benefit from programs to decrease progression from IGT to diabetes, and reduce cardiovascular risk. Starting management soon enough is a major problem in diabetes care - particularly for minorities which suffer disparities in health. By applying existing knowledge to disease control and prevention, our Specific Aims are the critical first steps to solve this problem.