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Screening for Type 2 Diabetes Mellitus

IN RESPONSE: Our review used rigorous methods and a structured approach to evaluate the effectiveness of screening asymptomatic persons for diabetes to improve health outcomes. Evaluating the appropriateness of treatment in persons diagnosed with diabetes because of the presence of symptoms was outside the scope of our review. In order to better understand the risks and benefits of screening, we evaluated direct evidence on benefits and harms of screening as well as indirect evidence, including effects of treatment of screen-detected and early diabetes and of more-intensive versus less-intensive treatments. As described in our results, we found that treatment for impaired fasting glucose or impaired glucose tolerance can reduce or delay the progression to diabetes. In terms of duration of follow-up, our analysis was not restricted to short-term trials. Our review included a well-conducted randomized trial of screening that found no mortality benefit of screening asymptomatic persons after 10 years (1) and a trial that found that treatment with lifestyle interventions was associated with reduced risk for all-cause and cardiovascular mortality in persons with impaired glucose tolerance after 23 years (2). Neither of these trials reported effects on microvascular outcomes, such as blindness or end-stage renal disease. Studies on the effects of diabetes treatment on microvascular outcomes were not done in asymptomatic persons with screen-detected disease; symptomatic populations were outside the scope of our review. Epidemiologic evidence on the association between diabetes and adverse health outcomes and uncontrolled observational studies on the effects of treatments are limited in their ability to show causality and are highly susceptible to bias, and such studies (3) cannot supersede well-designed and well-conducted trials on the effectiveness of early treatment. Rather, longer-term, well-conducted trials that evaluate macrovascular and microvascular outcomes are needed to better understand the effects of such treatment.