Screening for Type 2 Diabetes Not Recommended in Most Cases?

Except possibly for hypertensive patients, screening for type 2 diabetes provides few benefits, according to a report in the June 3rd Annals of Internal Medicine. Accordingly, revised guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend screening only for adults with sustained blood pressure above 135/80 mm Hg. See Publishers Comments Dr. Susan L. Norris from Oregon Health & Science University, Portland, Oregon states that, "Aggressive lifestyle changes can dramatically reduce the incidence of diabetes, but it is not clear whether the diagnosis of prediabetes confers any particular health benefit over and above what one might expect if all obese patients were counseled to pursue these lifestyle changes."

Dr. Norris and colleagues reviewed evidence to inform an update of the 2003 USPSTF recommendations on screening for type 2 diabetes and prediabetes.

The authors could identify no randomized controlled trials examining the effectiveness of a screening program for type 2 diabetes and no studies reporting treatment effects in an exclusively screening-detected or recently diagnosed diabetes cohort.

A recent meta-analysis suggested that tight glycemic control could result in modest reduction of macrovascular events in patients with type 2 diabetes, the report indicates, but the individual trials in the analysis showed largely nonsignificant results.
There was evidence that persons with diabetes benefit from control of blood pressure and lipid levels, but relevant studies did not include individuals with screening-detected diabetes.

Intensive lifestyle modification in persons with prediabetes delays the progression to clinical diabetes, the researchers note, but whether treatment alters final health outcomes could not be determined from the studies reviewed.

Based on these results, the revised USPSTF guidelines (also published in this issue of Annals of Internal Medicine) recommend "screen for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg."

The recommendations conclude, "Current evidence is insufficient to assess the balance of benefits and harms of routine screening in asymptomatic adults with blood pressure of 135/80 mm Hg or lower."

"Although there is a fair body of evidence that, over a period of years, glucose control and, especially, cardiovascular risk reduction may improve long-term health outcomes in persons with diagnosed type 2 diabetes, there is very little evidence indicating whether there is an incremental benefit of early treatment as a result of systematic screening of asymptomatic adults," Dr. Norris continued.

"We hope that researchers will continue to address the gaps in the current literature," she concluded.

Ann Intern Med 2008;148:,846-868.

Publishers Comments:  Can we can serious here!
This study is so flawed that it is an embarrassment to the medical community.  How can we ever educate and prevent people who are prone to diabetes from getting diabetes, if we don’t screen for elevated blood sugars.  In this issue we have a study that shows that elevated A1c’s can predict death even before you get diabetes.  Studies have shown that we spend over 12,000 dollars a year for healthcare for a person with diabetes and only 2500 dollars for a person without diabetes.  Studies have shown that if you get diabetes and don’t control it you will die years early and be miserable for the last years of your life. And we have studies that show if you diagnosis it early, you can improve your quality of life by making just small changes in your lifestyle.  Why do we need to prove that normal blood sugars are good for you?????  I don’t care how many studies we do showing that screening for early diagnosis of prediabetes or diabetes are done, no one will ever convince me that normal blood sugars are not attainable and that diagnosing diabetes and prediabetes and educating the patient as to what they can do to prevent diabetes will not improve their quality of life and reduce costs in their healthcare!  Send me your comments!  publisher@diabetesincontrol.com

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