Authors' objectives:

(i) To assess the benefit of screening for type 2 diabetes in metropolitan France.

(ii) To draw up proposals for implementing a screening programme.

Authors' results and conclusions: Appropriateness of a screening programme (critical literature analysis): - Clinical benefit: The criteria defined by the WHO suggest that targeted screening for type 2 diabetes in metropolitan France would bring clinical benefits. In most cases, published guidelines conclude that targeted opportunist screening is useful. The procedure used would be a fasting venous blood glucose test performed every 3 years. - Economic benefit: Cost-benefit modelling results for screening are at the threshold of positive and were very sensitive to the hypotheses studied. There are therefore no solid economic reasons to support or reject screening. Practical aspects of a screening programme (based on the opinions of the working group): - targeted opportunist screening of subjects aged over 45 with at least one risk indicator for type 2 diabetes, in addition to age, i.e. non-Caucasian and/or migrant; metabolic syndrome marker (overweight, hypertension, dyslipidaemia) according to ANAES definitions; family history of diabetes (first degree relative), in women, history of gestational diabetes and/or birth of a child weighing more than 4 kg, history of temporary induced diabetes. The screening procedure should be a fasting venous blood glucose test performed at the laboratory. Study of current practice in ordering blood glucose tests, which are very common in France, shows that follow-up and management of positive blood glucose tests needs to be improved. The test should be repeated every 3 years in subjects with negative results, every year in subjects with fasting hyperglycaemia, and between 1 and 3 years in subjects with one or more risk indicators; - targeted screening in the community in subjects aged over 45 who belong to one of the at-risk groups, with or without associated risk markers. Depending on the contact procedures established, the test could be a fasting venous blood glucose test in the laboratory or a blood glucose measurement from a capillary sample. Follow-up procedures will be the same as for opportunist screening. Simultaneous screening for diabetes and cardiovascular risk factors should be recommended.

Authors' recommendations: In view of the uncertain clinical and economic aspects, these guidelines should be implemented while studies are carried out specifically to verify the prevalence of undiagnosed diabetes, to assess the feasibility of the recommended programmes and to provide a short-term assessment of these programmes, including an assessment of follow-up after screening.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)