The growing importance of diabetes screening

Abstract

The work of Chatterjee et al. (7) and Kahn et al. (18), along with other recent reports, provide important new information on the merits and costs of screening for diabetes. Although the case for type 2 diabetes screening being cost saving is a dubious one, these new data confirm that screening high-risk patients for diabetes is a reasonable clinical strategy and not prohibitively expensive. Thus, these data can be interpreted as providing additional support for the current ADA type 2 diabetes screening recommendations. Conducting a definitive randomized trial to support or refute diabetes screening recommendations is increasingly unfeasible in the U.S. or most of Europe for a variety of reasons. Instead, we will be left with a large number of studies of varied design and conduct, and we must infer from their sometimes incongruent results a reasonable approach to diabetes screening. Several questions come up in this regard. First, to what extent will the recent endorsement of new A1C thresholds for the diagnosis of diabetes and pre-diabetes reshape the diabetes screening landscape (14)? Second will the new emphasis on comparative effectiveness, and the use of sophisticated instrumental variable or propensity score analytic strategies, increase the confidence we have in the results of large observational studies? Third, will revised simulation models that include new information reflecting the recent findings of ACCORD, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) change the calculus on cost-effectiveness of screening? Fourth, can organizations including ADA and USPSTF reach a common, practical understanding of what constitutes a reasonable approach to diabetes screening, so that primary care providers will have one, instead of multiple guidelines to follow? And finally, how will new genetic and other novel predictors of macrovascular or microvascular complications inform future diabetes screening strategies? We live in exciting times, and our collaborative effort to develop more effective and efficient diabetes screening strategies in conjunction with the development of improved primary preventive strategies is a signature challenge now faced by the worldwide diabetes community. © 2010 by the American Diabetes Association.