Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force.

BACKGROUND

Type 2 diabetes mellitus is associated with a heavy burden of suffering. Screening for diabetes is controversial.

PURPOSE

To examine the evidence that screening and earlier treatment are effective in reducing morbidity and mortality associated with diabetes.

DATA SOURCES

MEDLINE, the Cochrane Library, reviews, and experts, all of which addressed key questions about screening.

STUDY SELECTION

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.

DATA EXTRACTION

Two reviewers abstracted relevant information using standardized abstraction forms and graded articles according to U.S. Preventive Services Task Force criteria.

DATA SYNTHESIS

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.

CONCLUSIONS

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.