Asymptomatic diabetes: the difference between population-based and office-based screening

To compare the results between population-based and office-based diabetes screening.

In 1997, a population-based screening was performed on a group of government employees and retired subjects in the Makassar Municipality. Since the year 2000, we performed screening at the clinic. For clinical-based screening, we focused the screening on those with high risks for developing diabetes mellitus, i.e. all subjects aged > or =45 or those aged < 45 with one or more of the following abnormalities: obese (BMI > 25 kg/m2), elevated blood pressure (> or =140/90 mmHg in adults), family history of diabetes, previous identified IFG or IGT, HDL-cholesterol < or =35 mg/dl and/or triglyceride > or =250 mg/dL, and history of gestational diabetes mellitus or delivery of babies > or =4000 gram. For population-based screening, the criteria for diabetes mellitus was based on a single test 2-hours post load (75 gram glucose), while for office-based screening, the WHO l999 was used i.e. fasting and 2-hours post 75 gram glucose load (OGTT).

During the screening in the population, 941 subjects were screened, 290 women and 651 men. There were 51 diabetic subjects, or a prevalence of 5.42%, 21 women or 7.24% of all women, and 30 men or 4.60% of all men. At the clinical setting, 907 were screened, 483 women and 424 men. Among these subjects, 155 fulfilled the diabetes criteria, with a prevalence of 17.1%. There were 78 diabetic women or 16.1% of all women, and 77 men or 18.2% of all men. If the diagnosis of diabetes mellitus in the clinical setting is based only on 2 hours post load (the same as for population-based) only 70 patients can be detected, for a prevalence of 7.7%, which is still higher compared to the results of the population-based screening. All figures obtained from the office-based screening were higher as compared to the population-based results.

These results show that office-based screening detected more asymptomatic diabetes compared to population-based screening. It is suggested that early detection of asymptomatic diabetes is performed at the clinic, either at the hospital or doctor's private office.