Screening for Diabetes and Prediabetes Should Be Cost-Saving in Patients at

OBJECTIVEdAlthough screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk. RESEARCH DESIGN ANDMETHODSdFive screening tests were performed in 1,573 adults without known diabetesdrandom plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1Cdand a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes. RESULTSdCompared with no screening, cost-savings would be obtained largely from screen-ing those at higher risk, including those with BMI.35 kg/m2, systolic blood pressure $13