Screening adults for diabetes could result in significant cost-savings for healthcare systems compared to the costs of not screening individuals at all, according to researchers at Emory University. The researchers discussed their study, designed to see if there was economic justification for screening pre-diabetes and unrecognized diabetes since early treatment could help prevent or delay development of diabetes and its complications, during the American Diabetes Association’s annual meeting in New Orleans.

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.

Lawrence Phillips, a professor of medicine at Emory University School of Medicine, and his team screened 1,259adults who had never been diagnosed with diabetes. The volunteer participants underwent four screening tests, including random plasma and capillary glucose, and a 50-gram 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 75-gram 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 pre-diabetes. In addition, they concluded that costs for screening and three years of treatment with metformin, or change in lifestyle for individuals found to have pre-diabetes 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 pre-diabetes, 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,” says Phillips. “These data suggest that screening with preventive management should be implemented widely and that use of the glucose challenge test may be cost-effective.”