Screening adults for Type 2 Diabetes: A review of the evidence for the U.S. Preventive Services Task force

Sheps Center for Health Services Research, 725 Airport Road, CB # 7590, Chapel Hill, NC 27599-2949, USA.
Annals of internal medicine (Impact Factor: 17.81). 03/2003; 138(3):215-29. DOI: 10.7326/0003-4819-138-3-200302040-00015
Source: PubMed


Type 2 diabetes mellitus is associated with a heavy burden of suffering. Screening for diabetes is controversial.
To examine the evidence that screening and earlier treatment are effective in reducing morbidity and mortality associated with diabetes.
MEDLINE, the Cochrane Library, reviews, and experts, all of which addressed key questions about screening.
Studies that provided information about the existence and length of an asymptomatic phase of diabetes; studies that addressed the accuracy and reliability of screening tests; and randomized, controlled trials with health outcomes for various treatment strategies were selected.
Two reviewers abstracted relevant information using standardized abstraction forms and graded articles according to U.S. Preventive Services Task Force criteria.
No randomized, controlled trial of screening for diabetes has been performed. Type 2 diabetes mellitus includes an asymptomatic preclinical phase; the length of this phase is unknown. Screening tests can detect diabetes in its preclinical phase. Over the 10 to 15 years after clinical diagnosis, tight glycemic control probably reduces the risk for blindness and end-stage renal disease, and aggressive control of hypertension, lipid therapy, and aspirin use reduce cardiovascular events. The magnitude of the benefit is larger for cardiovascular risk reduction than for tight glycemic control. The additional benefit of starting these treatments in the preclinical phase, after detection by screening, is uncertain but is probably also greater for cardiovascular risk reduction.
The interventions that are most clearly beneficial during the preclinical phase are those that affect the risk for cardiovascular disease. The magnitude of additional benefit of initiating tight glycemic control during the preclinical phase is uncertain but probably small.

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Available from: Katrina Donahue, Sep 02, 2014
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    • "For the screening alone strategy, the extra time was 0.04 years, which is comparable to the range of 0.02–0.08 reported in the UK and Taiwan [19,20,26]. Consequently, the strategy of screening alone, which results in early monitoring or treatment for diabetes, can improve health [49]. In terms of preventing complications, there is now a broad consensus that the earlier diabetes is detected and treated, the greater the likelihood that complications will be prevented or delayed [27]. "
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    • "Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective in overweight or obese individuals [14]. Simple attention to lifestyle has been demonstrated to be superior to medications for the prevention and delay of T2D in several studies [15-19]. Furthermore, this approach will have a positive impact on the lipid abnormalities [20]. "
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