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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Detecting Impaired Fasting Glucose
Prediabetes and screening tools
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Doyle M. Cummings, Greenville, NC, USA Professor, Family Medicine
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I read with interest the recent paper by Koopman et al describing the development and validation of the TAG-IT screening tool for detecting impaired fasting glucose. With the epidemic of diabetes in both adults and children, new tools are needed that can be used in larger populations to more quickly identify those at higher risk for the subsequent development of prediabetes and diabetes. While the tool has the potential for substantial utility, particularly in high risk populations, its use in primary care practices or in community-based population groups, its accuracy of prediction when used prospectively in comparison to other possible measures, and the economic considerations associated with its use in various subgroups with varying risk levels remain untested. In particular, the identification of specific cut points that would trigger additional testing or referral, particularly in primary care practices with electronic health record data available, need to be prospectively investigated, as suggested by the authors. Further, the authors have chosen to develop the tool without race as a variable so as to be broadly applicable. However, both obesity and diabetes prevalence appear to differ considerably by race and gender, and the potential value of including race in the model in an effort to improve predictability might also be considered. The present tool is also limited to adults 20 – 64 yr. of age and impaired fasting glucose is clearly a problem in patients beyond either end of this range. From a preventive medicine perspective, a similar tool might be particularly useful in at-risk children who have a growing incidence of impaired fasting glucose and diabetes. Competing interests: None declared |
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Monica Franciosi, S. Maria Imbaro (CH), Italy Researcher - Consorzio Mario Negri Sud
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Diabetes prevention is a pivotal issue for all the professionals involved in health care. Thus, the use of effective and simple screening tool for high-risk conditions (i.e. prediabetes or metabolic syndrome) is desirable, and TAG-IT represents a useful instrument in clinical setting. As argued by the authors, economic evaluation could be useful to identify the threshold that should trigger additional tests, such as OGTT. In fact, it is noteworthy to underline that prediabetes includes also IGT and that the vast majority of early cases of asymptomatic T2D and IGT will not be detected by measuring only fasting glucose (1). In addition, it could be useful to assess the performance (sensitivity/specificity) of TAG-IT among younger age classes or to estimate the percentage of people presenting high-risk condition, such as metabolic syndrome, according TAG-IT scores. The comparison with other validated prediction scores not requiring clinical data (i.e. heart rate) would further help in choosing the simplest and more effective screening tool. Finally, it could be emphasized that screening procedures represent only the first step for diabetes prevention. The next challenge should be the implementation of effective diabetes prevention strategies among high risk population in the context of clinical setting. 1. DECODE-study group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. BMJ 1998; 317: 371-375. Competing interests: None declared |
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