Russell Harris, MD, MPH; Katrina Donahue, MD, MPH; Saif S. Rathore, MPH; Paul Frame, MD; Steven H. Woolf, MD, MPH; Kathleen N. Lohr, PhD
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Grant Support: This study was conducted by the Research Triangle InstituteUniversity of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (contract no. 290-97-0011, task order 3).
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Current Author Addresses: Dr. Harris: Sheps Center for Health Services Research, 725 Airport Road, CB # 7590, Chapel Hill, NC 27599-2949.
Dr. Donahue: University of North Carolina, CB #7595 Manning, Chapel Hill, NC 27599.
Dr. Rathore: Yale University School of Medicine, PO Box 208025, New Haven, CT 06520-8025.
Dr. Frame: Tri-County Family Medicine, Box 112, Cohocton, NY 14826.
Dr. Woolf: Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033.
Dr. Lohr: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709.
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.
Table 1. Randomized, Controlled Trials of Tight Glycemic Control
Table 2. Studies of Intensity of Treatment with Antihypertensive Medications
Table 3. Studies Comparing One Antihypertensive Drug with Another
Table 4. Meta-Analyses of Comparisons of Antihypertensive Drugs
Table 5. Number Needed To Screen for Diabetes To Prevent One Adverse Event
Analytic framework for screening for type 2 diabetes. KQ = key question.
Appendix Table 1. Eligibility Criteria, Search Strategy, and Results of Searches
Appendix Table 2. Search Strategies
Selection of articles based on key question 1. RCT = randomized, controlled trial.
Selection of articles based on key question 2. RCT = randomized, controlled trial.
Selection of articles based on key question 3.
Selection of articles based on key question 4. RCT = randomized, controlled trial.
Selection of articles based on key question 5.
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Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN. Screening Adults for Type 2 Diabetes: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;138:215–229. doi: 10.7326/0003-4819-138-3-200302040-00015
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Published: Ann Intern Med. 2003;138(3):215-229.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Guidelines.
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