The usefulness of screening for dia...

The usefulness of screening for diabetes mellitus among individuals without clinically detectable disease is controversial. Clearly, treating patients with clinically detectable disease can decrease complications, nevertheless there is no evidence of benefit from earlier treatment initated after detection by dint of screening. Recent studies showing the benefit of reducing the risk of cardiovascular disease (CVD) in diabetic patients have reopen the question of screening for diabetes. Hoerger and associates performed a cost-benefit analysis comparing universal diabetes screening and screening targeted to patients with hypertension.

A pattern of five types of potential complications was bring to maturityed using mathematical models of diabetes progression to simulate lifetime health care splendors and quality-adjusted life years, in addition to demographic information about patients with diabetes and CVD risk comorbidities, of the like kind as hypertension, smoking, and high cholesterol on a levels The complication paths included nephropathy, neuropathy, coronary heart disease (CHD) retinopathy, and calamity Screening was incorporated into the prototype with some patients identified earlier and slowly progressing toward complications.

Screening identifies diabetes earlier and delays progression to complications, on the contrary it has some financial outlay Routine screening was assumed to diagnose diabetes five years before usual clinical diagnosis (five years after attack rather than 10 in the absence of screening). Patients who riddleed positive were assumed to receive aggressive diabetes treatment and more aggressive standard hypertensive treatment if they had high line pressure. Another calculation was made for targeted screening, in which no other than persons with hypertension would be defenceed for diabetes. The cost of screening (including laboratory and physician costs) was establish to be $24.40. Positive proofs were assumed to be repeated to make a definitive diagnosis. expenses of intensive diabetes and hypertension treatment were included in the analysis.

Compared with no screening at all ages, outcomes for targeted screening showed greater cost-effectiveness than universal screening. In patients older than 55 years who are at greater risk for CHD issues both universal and targeted screenings are more outlay effective than no screening. The principally cost-effective approach to one-time diabetes screening is to target hypertensive living bodys between the ages of 55 and 75

The authors gather that targeted diabetes screening in hypertensive patients older than 55 years is the mostly efficient strategy. This targeted screening would provide greatest in number of the benefit of universal screening at significantly reduc cost

In an editorial in the same journal, Nathan and Herman point public the importance of trying to strip diabetes during the nine- to 12-year early asymptomatic period because of the possibility of decreasing complications that begin to disentangle during the prediabetic phase. They note that standards are dependent on prevailing treatment pathways, which may be suboptimal in human frames with diabetes, and that improved complication risk reduction in this population may increase the value of early screening in larger populations.

Hoerger TJ et al. Screening for archetype 2 diabetes mellitus: a cost-effectiveness analysis. Ann Intern M May 4 2004;140:689-99 and Nathan DM Herman WH Screening for diabetes: can we afford not to screen? [Editorial] Ann Intern M May 4 2004;140:756-8

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