Routine Diabetes Screenings Could Cut
Screening adults for diabetes
could result in significant cost-savings for health care systems
compared to the costs of not screening individuals at all.
Emory University researchers
will present the findings of their diabetes screening cost
analysis at the annual meeting of the American Diabetes
"The economic costs of
diabetes threaten the financial integrity of our health care systems,"
said study co-author Dr. Lawrence S. Phillips, Emory
University School of Medicine Professor of Medicine, Division of
Endocrinology. "We asked whether there is economic justification for
screening for prediabetes and unrecognized diabetes since early
treatment could help prevent or delay development of diabetes and its
complications and reduce associated costs."
Phillips and his research
team screened 1,259 adults who had never been diagnosed with diabetes.
The volunteer participants underwent four screening tests, including
random plasma and capillary glucose, and a 50g oral glucose challenge
test (without a prior fast, at different times of the day) with plasma
and capillary glucose measured one hour after the glucose drink. All
participants also had a definitive 75g oral glucose tolerance test
(OGTT) performed in the morning after an overnight fast.
The researchers found that 24
percent of the adults screened had either diabetes or prediabetes. In
addition, they concluded that costs for screening and three years of
treatment with metformin, or change in lifestyle for individuals found
to have prediabetes or previously unrecognized diabetes, would be lower
than costs for not screening.
The costs of two-step
screening (only positive screens would have the OGTT) were projected to
include the costs of testing, costs for false negatives (in individuals
where the diagnosis would be missed), and costs for treatment of true
positives (people found to have diabetes or prediabetes, treated with
metformin, or change in lifestyle).
Projected health system costs
for diabetes screening and management over a three-year period ranged
from about $180,000 to $186,000 – all lower than costs for no
screening, which would be about $206,000.
"We found that projected
health system costs for screening and either treatment would be less
than costs for no screening," said Phillips. "These data suggest that
screening with preventive management should be implemented widely and
that use of the glucose challenge test may becost-effective."
Diabetes is a disease in
which the body does not produce or properly use insulin. Insulin is a
hormone that is needed to convert sugar, starches and other food into
energy needed for daily life.
According to the American
Diabetes Association, 23.6 million U.S. children and adults, or 7.8
percent of the population, have diabetes. While an estimated 17.9
million have been diagnosed with diabetes, 5.7 million people are
unaware that they have the disease.
Pre-diabetes is a condition
that occurs when a person's blood glucose levels are higher than normal
but not high enough for a diagnosis of type 2 diabetes. There are 57
million Americans who have pre-diabetes, in addition to the 23.6
million with diabetes.
In addition to Phillips,
study authors were: K.M. Venkat Narayan, MD, MSc, MBA, and Joseph
Lipscomb, PhD, of Emory University; and Dr. Ranee Chatterjee, of the
Johns Hopkins University School of Medicine. Chatterjee was lead study
The research was supported in
part by the National Institutes of Health and the National Center for
For more information on Emory
University, visit www.emory.edu.