Authors' objectives:

To examine the evidence of the benefits and harms of screening and earlier treatment in reducing the complications of type 2 diabetes mellitus (DM-2).

Authors' results and conclusions: No large RCT of screening has been performed. Thus, the evidence for the benefits of screening is indirect. A detectable preclinical period exists, but its length is uncertain. Screening tests with adequate accuracy, reliability, and acceptability are available. The health outcomes of blindness, chronic renal failure, and lower extremity amputation occur infrequently until 20 years or longer of diabetes duration. Trials of treatment after clinical diagnosis have found it difficult to demonstrate a statistically significant health benefit. How much these outcomes would be reduced by the additional few years of treatment produced by screening is uncertain. Visual impairment less severe than blindness and cardiovascular (CVD) events are more common complications in the decade after diabetes diagnosis. Tight control of blood pressure is effective in reducing these complications among those already clinically diagnosed with DM-2 and hypertension. Little information is available about harms of screening, although several harms are potentially serious problems. The costs of diagnosis, treatment, and dealing with the complications of DM-2 are high. One study examined the cost-effectiveness of screening for DM-2 but assumed that the only effective treatment was glycemic control.

Authors' recommendations: The evidence for screening for DM-2 is indirect and mixed. The strongest case for screening comes from earlier detection and treatment of CVD risk factors, especially hypertension. An RCT of screening is needed to answer the many remaining questions.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)