Author

Eva L. Evans

Date of Award

5-1-2014

Degree Type

Dissertation

Degree Name

Doctor of Public Health

Field of Study

Epidemiology

Department

School of Public Health

First Advisor

David Sterling

Second Advisor

Lori Fischbach

Third Advisor

Martha J. Felini

Abstract

Almost 37% of persons living in the US aged > 18 years have pre-diabetes, Persons with pre-diabetes are at high risk of developing type-2 diabetes (advanced hyperglycemia) and also have a higher risk of cardiovascular disease than those with normal blood glucose levels. Furthermore, results from cross-sectional studies indicate that microvascular complications arising from hyperglycemia may begin at the pre-diabetic stage. There is evidence that progression of pre-diabetes may be halted or even reversed with lifestyle and pharmaceutical interventions. However, less than 10% of US adults with pre-diabetes are aware of their condition, which indicates that current pre-diabetes screening methods are inadequate.

US physicians need a comprehensive pre-diabetes screening tool. To this end, non-invasive screening score sets were created to screen for IFG, IGT and elevated HbA1c. Because preliminary analyses indicated that the screening accuracy of the pre-diabetes screening score sets would be enhanced by not restricting the score sets to only the pre-diabetic ranges of hyperglycemia, the pre-diabetes screening tool was designed to screen for hyperglycemia in the pre-diabetic and diabetic ranges. These hyperglycemia screening score sets have been based on a scoring system of non-invasive factors associated with hyperglycemia that are already routinely measured or assessed during a visit to the doctor. These factors were age, gender, smoking status, diabetes family history, history of cardiovascular disease, history of hypertension, height, body mass index, physical activity level (by surrogate measure of fasting heart rate), level of alcohol consumption, history of early menarche (women only), and history of gestational diabetes (parous women only). To boost performance for the non-invasive fasting hyperglycemia score set and the non-invasive elevated HbA1c screening score set, both for use in parous women, the fasting screening score set and the HbA1c screening score set included the factor, ethnicity. The pre-diabetes tools were externally and internally validated and were also compared to other non-invasive methods that might be used to screen for hyperglycemia.

Comments

Evans, Eva L. Pre-diabetes Screening Tools for Adults Living in the United States. Doctor of Public Health (Epidemiology), May, 2014, 217pp., 30 tables, 8 illustrations, bibliography, 111 titles.