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Task Force Weighs Evidence on Diabetes Screenings

USPSTF researchers find that screening for diabetes did not improve mortality rates after 10 years of follow-up but treatment of IFG or IGT was associated with delayed progression to type 2 diabetes….

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Approximately 21 million people in the U.S. received a diabetes diagnosis in 2010 and an estimated 8 million cases went undiagnosed. Screening asymptomatic people for diabetes may lead to earlier identification and earlier or more-intensive treatments, potentially improving health outcomes.

Researchers reviewed studies published from 2007 through October 2014 to assess the benefits and harms of screening for type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance among asymptomatic adults. The evidence suggests that screening asymptomatic, nonpregnant adults for type 2 diabetes could help to delay progression to diabetes by identifying those who could benefit from treatment of impaired fasting glucose and impaired glucose tolerance. However, screening did not improve mortality rates after 10 years of follow up.

In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended that physicians should screen for type 2 diabetes in asymptomatic adults with treated or untreated sustained blood pressure greater than 135/80 mm Hg. This recommendation was based on the ability of screening to identify persons with diabetes and evidence that more-intensive blood pressure treatment was associated with reduced risk for cardiovascular events, including cardiovascular mortality, in patients with diabetes and hypertension. Since then, evidence shows that an intensive multifactorial intervention for screen-detected diabetes aimed at decreasing glucose and lipid levels and blood pressure was not associated with a reduction in risk for all-cause or cardiovascular mortality or morbidity compared with standard treatment. The USPSTF posted draft recommendations for public comment in October 2014. The Task Force is currently incorporating public comment to finalize those recommendations for future release.

Practice Pearls:

  • In 2008, the USPSTF recommended that physicians should screen for type 2 diabetes in asymptomatic.
  • Evidence shows that an intensive multifactorial intervention for screen-detected diabetes aimed at decreasing glucose and lipid levels and blood pressure was not associated with a reduction in risk for all-cause or cardiovascular mortality compared with standard treatment.
  • Screening for diabetes did not improve mortality rates after 10 years of follow-up.

Shelley Selph. Screening for Type 2 Diabetes Mellitus: A Systematic Review for the U.S. Preventive Services Task Force. Published online 14 April 2015 doi:10.7326/M14-2221 Annals of Internal Medicine.