Susan L. Norris, MD, MPH; Devan Kansagara, MD; Christina Bougatsos, BS; Rongwei Fu, PhD
Acknowledgment: The following people provided valuable guidance and insights: Mark Helfand, MD, MPH, Evelyn Whitlock, MD, MPH, and Peggy Nygren, MA, of the Oregon Evidence-based Practice Center; Tracy Wolff, MD, MPH, and Mary Barton, MD, MPP, at the Agency for Healthcare Research and Quality; and the U.S. Preventive Services Task Force members Ned Calonge, MD, Russ Harris, MD, MPH, George Isham, MD, MS, and Virginia Moyer, MD, MPH. The authors thank Andrew Hamilton, MLS, MS, for assistance in developing and running search strategies; Peggy Nygren, MA, and Tracy Dana, MLS, for assistance with data abstraction; and Sarah Baird, MS, for technical assistance.
Grant Support: This report was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-02-0024, Task Order no. 2 for the U.S. Preventive Services Task Force).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Susan L. Norris, MD, MPH, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Stop B1CC, Portland, OR 97239.
Current Author Addresses: Drs. Norris and Fu and Ms. Bougatsos: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Stop BICC, Portland, OR 97239.
Dr. Kansagara: Portland Veterans Administration Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR 97239.
More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes.
To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings.
MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007.
Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients.
Relevant data were abstracted in duplicate into a standardized template.
Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed.
Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations.
Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.
KQ = key question.
Study flow diagram.
KQ = key question. *Cochrane databases were the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects. †Other sources were reference lists and expert referrals.
Appendix Table 1. Randomized, Controlled Trials of Hypertension Treatment in Diabetic Populations
Appendix Table 2. Randomized, Controlled Trials of Lipid Interventions in Diabetic and Nondiabetic Populations*
Appendix Table 3. Randomized, Controlled Trials of Interventions in Prediabetes
Diabetes incidence in lifestyle trials.
DPP = Diabetes Prevention Program.
Diabetes incidence in drug trials.
DPP = Diabetes Prevention Program; DREAM = Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication.
Table 1. Summary of Evidence
Table 2. Number Needed to Screen for Type 2 Diabetes to Prevent 1 Adverse Event after 5 Years of Additional Treatment
Table 3. Number Needed to Screen for Prediabetes to Prevent 1 Case of Diabetes after 3 Years
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Norris SL, Kansagara D, Bougatsos C, Fu R. Screening Adults for Type 2 Diabetes: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:855-868. doi: 10.7326/0003-4819-148-11-200806030-00008
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Published: Ann Intern Med. 2008;148(11):855-868.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Guidelines.
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