Conclusions HbA1c is neither sensitive nor specific for detecting pre‐diabetes ; fasting glucose is specific but not sensitive .
Interventions in people classified through screening as having pre‐diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial population s. As screening is inaccurate , many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention .
These findings suggest that “ screen and treat ” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes .
& NA ; Objectives To assess diagnostic accuracy of screening tests for  pre‐diabetes  and efficacy of interventions ( lifestyle or metformin ) in preventing onset of type 2 diabetes in people with pre‐diabetes .
Effects of telephone-delivered lifestyle support on the development of diabetes in participants at high risk of type 2 diabetes: J-DOIT1, a pragmatic cluster randomised trial
Objectives To examine the effects of telephone-delivered lifestyle coaching on preventing the development of type 2 diabetes mellitus ( T2DM ) in participants with impaired fasting glucose ( IFG ) . Design Cluster r and omised trial . Setting 40 groups from 17 healthcare divisions in Japan : companies ( 31 ) , communities ( 6 ) and mixed setting s ( 3 ) . Participants Participants aged 20–65 years with fasting plasma glucose ( FPG ) of 5.6–6.9 mmol/L were invited from the 17 healthcare divisions . R and omisation The groups were then r and omly assigned to an intervention or a control arm by independent statisticians according to a computer-generated list . Intervention The intervention arm received a 1-year telephone-delivered intervention provided by three private lifestyle support centres ( at different frequencies : low-frequency ( 3 times ) , middle-frequency ( 6 times ) and high-frequency ( 10 times ) support calls ) . The intervention and control arms both received self-help devices such as a weight scale and pedometer . Outcomes Participants were followed up using data from annual health check-ups and a question naire regarding lifestyle . The primary outcome was the development of T2DM defined as FPG ≥7.0 mmol/L , the diagnosis of diabetes , or use of an antidiabetic drug , confirmed by referring to medical cards . Results Of 14 473 screened individuals , participants were enrolled in either the intervention ( n=1240 ) arm or control ( n=1367 ) arm . Overall , the HR for the development of T2DM in the intervention arm during 5.5 years was 1.00 ( 95 % CI 0.74 to 1.34 ) . In the sub analysis , the HR was 0.59 ( 95 % CI 0.42 to 0.83 ) in the subgroup that received phone calls the most frequently , compared with the control arm . A limitation of the study includes a lack of blinding . Conclusions High-frequency telephone-delivered lifestyle support could effectively prevent T2DM in participants with IFG in a primary healthcare setting , although low-frequency and middle-frequency phone calls did not . Trial registration number This trial has been registered with the University Hospital Medical Information Network ( UMIN000000662 )
Conclusions HbA1c is neither sensitive nor specific for detecting pre‐diabetes ; fasting glucose is specific but not sensitive .
Interventions in people classified through screening as having pre‐diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial population s. As screening is inaccurate , many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention .
These findings suggest that “ screen and treat ” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes .
& NA ; Objectives To assess diagnostic accuracy of screening tests for  pre‐diabetes  and efficacy of interventions ( lifestyle or metformin ) in preventing onset of type 2 diabetes in people with pre‐diabetes .