Background: Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed\nscreening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening\nintervals may differ substantially when considering individual risk for diabetes.\nMethods: This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to\nMarch 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals\nbased on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We\nadapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a\nlinear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as\ninformative when the signal-to-noise ratio exceeded 1.\nResults: Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48\n(30ââ?¬â??74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30ââ?¬â??44 years old, HbA1c\nscreening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMI > 30)\nyears, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ââ?°Â¥20%) years. This trend\nwas consistent in other age and risk groups as well; among obese 30ââ?¬â??44 year olds, we found substantially\nshorter intervals compared to other groups.\nConclusion: HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk\nstratification should be applied when deciding an optimal HbA1c screening interval in the general population\nto minimize overdiagnosis and overtreatment.
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