Gerald W. Smetana, MD; Martin J. Abrahamson, MB ChB (*); David M. Rind, MD (*)
Acknowledgment: The authors thank the patient for sharing his story.
Grant Support: Beyond the Guidelines receives no external support.
Disclosures: Dr. Rind reports personal fees from UpToDate outside the submitted work. Dr. Abrahamson has served on Advisory Boards for Novo Nordisk. Authors not named here have no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1091.
Requests for Single Reprints: Gerald W. Smetana, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, email@example.com.
Current Author Addresses: Drs. Smetana, Abrahamson, and Rind: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
The prevalence of diabetes in the United States is rising. Twelve percent of U.S. adults have diabetes and another 37% have impaired fasting glucose or impaired glucose tolerance. Diabetes is a major risk factor for such outcomes as cardiovascular disease, blindness, chronic kidney disease, and limb amputation. An important consideration is whether screening for abnormal glucose levels or diabetes reduces cardiovascular or all-cause morbidity and mortality. In October 2015, the U.S. Preventive Services Task Force published recommendations on screening for abnormal blood glucose and concluded that intensive lifestyle interventions have a moderate benefit in reducing progression to diabetes in patients who have abnormal blood glucose levels detected by screening. It found inadequate evidence that such screening reduces cardiovascular or all-cause mortality and no evidence of psychological or other harms from screening. The Task Force recommends glucose screening
every 3 years for adults aged 40 to 70 years who are overweight or obese and do not have symptoms of diabetes. In this article, we present the case of a man who meets these criteria and explore his preferences and concerns regarding screening. Two experts then debate screening merits and benefits, the significance of abnormal blood glucose levels and diabetes as cardiovascular risk factors, and application of the guidelines to this particular patient.
Smetana GW, Abrahamson MJ, Rind DM. Should We Screen for Type 2 Diabetes?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2016;165:509–516. doi: 10.7326/M16-1091
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Published: Ann Intern Med. 2016;165(7):509-516.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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