Type 2 diabetes is a chronic, and progressive, condition that may develop silently for many years before symptoms are apparent and a formal diagnosis is made. Diabetes is linked to various long-term complications such as heart disease, impaired circulation and eye problems. It can also be slowed down, or controlled, through lifestyle modification, such as keeping to a healthy weight, and through medication. Therefore, it makes sense to detect diabetes, and its precursor conditions, known as insulin resistance and impaired glucose tolerance, as soon as possible. 

For its part, the American Diabetes Association recommends that screening should be considered in overweight or obese individuals who have one or more additional risk factors, such as large waist circumference. If risk factors are not present, testing should begin at age 45 and be repeated every three years. We do not yet know what the benefits of such targeted screening are, compared to no screening. Nor do we know whether mass screening for diabetes would be worthwhile. 

A screening program for diabetes involves considerable healthcare costs. So it is worthwhile gathering evidence on what age it should be started, how often it should be done, and whether a targeted or population-based approach is preferable, Researchers at the American Diabetes Association and at a number of other diabetes centers around the world now present the results of a mathematical model comparing eight different diabetes screening strategies, six of which were population-based while the other two were targeted strategies.

The population used was drawn from data from a sample of the US population, creating a group of 325,000 people without diabetes. The model measured whether screening could reduce the incidence of type 2 diabetes, heart attack, stroke and circulation complications (foot and eye complications). They also measured how screening for diabetes would impact healthcare costs, quality of life, and cost per quality-adjusted life-year (QALY). The last is a measure often used in healthcare economics and, put simply, is a measure of cost put into healthcare for the gain in healthy quality of life.

Compared to no screening, all strategies for diabetes screening reduced the risk of heart attack and circulation complications as well as increasing the number of QALYs. Most of the strategies reduced the number of death but did not have any impact on stroke risk. Costs were higher if diabetes screening was begun at 45 and done every year, if it was begun at 60 and done every three years, and if it was begun at 30 and repeated every six months – this last being a maximum screening strategy. In conclusion, the best approach is to begin screening between the ages of 30 and 45 years and to repeat every three to five years.   If you have never been screened for type 2 diabetes, why not ask your doctor if this would be appropriate the next time you have a routine blood pressure check?

Source: 

Kahn R et al Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis The Lancet 17^th April 2010;375:1365-74