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Aim To evaluate the U.S. population-level impact of two alternatives for initial type 2 diabetes screening [opportunistic random plasma glucose (RPG) 6.7 mmol/l and a 1-h 50-g glucose challenge test (GCT) 8.9 mmol/l] compared with American Diabetes Association (ADA)-recommended tests. Methods Using a sample (n = 1471) from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 that represented 145 million U.S. adults at high risk for developing type 2 diabetes, we simulated a two-test screening process. We c