Screening adults for type 2 diabetes

A review of the evidence for the U.S. preventive services task force

Susan L. Norris, Devan Kansagara, Christina Bougatsos, Rongwei (Rochelle) Fu

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background: More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes. Purpose: To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings. Data Sources: MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007. Study Selection: Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients. Data Extraction: Relevant data were abstracted in duplicate into a standardized template. Data Synthesis: Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed. Limitations: Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations. Conclusion: Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.

Original languageEnglish (US)
Pages (from-to)855-868
Number of pages14
JournalAnnals of Internal Medicine
Volume148
Issue number11
StatePublished - Jun 3 2008

Fingerprint

Prediabetic State
Advisory Committees
Type 2 Diabetes Mellitus
Insurance Benefits
Life Style
Mass Screening
Information Storage and Retrieval
MEDLINE
Population
Libraries
Observational Studies
Meta-Analysis
Primary Health Care
Randomized Controlled Trials
Blood Pressure
Hypertension
Incidence
Health
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Screening adults for type 2 diabetes : A review of the evidence for the U.S. preventive services task force. / Norris, Susan L.; Kansagara, Devan; Bougatsos, Christina; Fu, Rongwei (Rochelle).

In: Annals of Internal Medicine, Vol. 148, No. 11, 03.06.2008, p. 855-868.

Research output: Contribution to journalArticle

Norris, Susan L. ; Kansagara, Devan ; Bougatsos, Christina ; Fu, Rongwei (Rochelle). / Screening adults for type 2 diabetes : A review of the evidence for the U.S. preventive services task force. In: Annals of Internal Medicine. 2008 ; Vol. 148, No. 11. pp. 855-868.
@article{5c728c6c0eb74787b1c8438031cdd955,
title = "Screening adults for type 2 diabetes: A review of the evidence for the U.S. preventive services task force",
abstract = "Background: More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes. Purpose: To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings. Data Sources: MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007. Study Selection: Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients. Data Extraction: Relevant data were abstracted in duplicate into a standardized template. Data Synthesis: Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed. Limitations: Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations. Conclusion: Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.",
author = "Norris, {Susan L.} and Devan Kansagara and Christina Bougatsos and Fu, {Rongwei (Rochelle)}",
year = "2008",
month = "6",
day = "3",
language = "English (US)",
volume = "148",
pages = "855--868",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "11",

}

TY - JOUR

T1 - Screening adults for type 2 diabetes

T2 - A review of the evidence for the U.S. preventive services task force

AU - Norris, Susan L.

AU - Kansagara, Devan

AU - Bougatsos, Christina

AU - Fu, Rongwei (Rochelle)

PY - 2008/6/3

Y1 - 2008/6/3

N2 - Background: More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes. Purpose: To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings. Data Sources: MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007. Study Selection: Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients. Data Extraction: Relevant data were abstracted in duplicate into a standardized template. Data Synthesis: Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed. Limitations: Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations. Conclusion: Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.

AB - Background: More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons. In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes. Purpose: To update the 2003 U.S. Preventive Services Task Force review on the evidence for potential benefits and harms of screening adults for type 2 diabetes and prediabetes in primary care settings. Data Sources: MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007. Study Selection: Trials and observational studies that directly addressed the effectiveness and adverse effects of screening interventions were included. Randomized, controlled trials were used to assess the effectiveness of diabetes and prediabetes treatments. For diabetes interventions, trials of patients with disease for 1 year or less were included, as well as trials comparing outcomes among diabetic and nondiabetic patients. Data Extraction: Relevant data were abstracted in duplicate into a standardized template. Data Synthesis: Data were synthesized in a qualitative manner, and a random-effects meta-analysis of the effects of interventions in prediabetes on the incidence of diabetes was performed. Limitations: Most of the data on diabetes treatment were not from primary trial data but from subgroup analyses. Participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations. Conclusion: Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations. Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes.

UR - http://www.scopus.com/inward/record.url?scp=44649126707&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=44649126707&partnerID=8YFLogxK

M3 - Article

VL - 148

SP - 855

EP - 868

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 11

ER -