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Long-term Effects of Type 2 Diabetes Screening

Does screening help reduce the risk of cardiovascular disease for type 2 diabetes patients?…

Previous studies have shown that diabetes screening can reduce the risk of cardiovascular disease (CVD) and myocardial infarction. In addition, diabetes screening also helps in detecting and changing unhealthy behaviors. However, self-rated health is often overlooked in screening programs. Researchers conducted a survey to analyze the long-term effects of a diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behavior.

This pragmatic, primary care-based, parallel-group, cluster-randomized controlled trial (ADDITION-Cambridge study) consisted of 32 general practices in Eastern England, which were randomized into 2 groups: control group (5 practices, n=4,137) or screening group (27 practices, n=16,047). Inclusion criteria included high-risk type 2 diabetes patients aged from 40 to 69 years (n=20,184). Exclusion criteria included pregnancy, lactation, an illness with a likely prognosis of less than 1 year, and a psychiatric illness, or invalidated informed consent. The screening program included random capillary blood glucose and glycated hemoglobin (HbA1c) testing at an initial practice visit, fasting capillary blood glucose testing at a subsequent visit, and a standard 75g oral glucose tolerance test for diabetes diagnosis confirmation. A questionnaire survey was sent to a random sample of each group 7 years after the screening. The questionnaire included information about prevalence of cardiovascular disease events, cardioprotective medications, lifestyle, diet, self-rated health, health behaviors, and health service usage over the last 3 months. Logistic regression and linear regression were used for categorical and continuous outcomes, respectively.

Compared to non-responders, responders to the questionnaire were female, older, taking hypertensive medications, having low body mass index (BMI), and having higher risk of undiagnosed diabetes at baseline (all p-value <0.05). At the end of the study, both screening and control group had about the same number of patients having heart attack or stroke (OR=0.90, 95% CI, 0.71-1.15). There was no significant difference between both groups in self-rated health status (β: -0.33, 95% CI, -1.80 to 1.14), visual analogue score (β: 0.80, 95% CI, -1.28 to 2.87), total physical activity (β: 0.50, 95% CI, -4.08 to 5.07), current smoking (OR 0.97, 95% CI, 0.72 to 1.32), and alcohol consumption (β: 0.14, 95% CI, -1.07 to 1.35). Moreover, the study also showed that participants with negative screening did not have less healthy behaviors compared to those in the no-screening control group.

After 7 years of follow-up, type 2 diabetes screening was not shown to have beneficial long-term effects in CVD morbidity or health behaviors. Self-rated functional status and health service use were also not adversely associated with screening.

Practice Pearls:

  • No long-term beneficial effects on CVD morbidity, self-rated health, and health behaviors are associated with type 2 diabetes screening.
  • Additional benefits for those who developed diabetes after the first round of screening were not studied.
  • Due to the fact that the population was done in England, and the study population was almost entirely Caucasian, selection bias were present in the study.

Justin B. Echouffo-Tcheugui, Rebecca K. Simmons, Toby Prevost, Kate M. Williams, Ann-Louise Kinmonth, Nicholas J. Wareham, Simon J. Griffin. “Long-Term Effect of Population Screening for Diabetes on Cardiovascular Morbidity, Self-Rated Health, and Health Behavior.” Ann Fam Med. 2015 Mar;13(2):149-57.