Research revives debate over timing of type 2 diabetes screening

by Barbara Hewitt on June 9, 2015

New research has re-opened a debate over whether earlier screening, diagnosis and treatment of type 2 diabetes could decrease the risk of cardiovascular problems.

A new study carried out by researchers from the University of Michigan used a computer model known as the Michigan Model which simulates the progression of diabetes and its complications, resulting health problems, quality of life and costs.

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Could earlier diabetes screening prevent cardiovascular issues?

The team used data from a large European study of people aged 40 to 69 without known diabetes who were screened and treated for the condition. In the original study, some participants who tested positive were treated intensively while others were treated routinely, and the authors found no difference in cardiovascular outcomes or death five years later.

This new study set out to estimate what may have happened to the participants over the same five-year period if they had not been screened and their diabetes diagnoses had been delayed by three or six years.

If screening was delayed by three years, the researchers estimated that about 11% of people would likely experience a heart problem within five years, compared to about 8% when screening wasn’t delayed. If screening was delayed by six years, they estimated that about 13% of participants would experience a heart problem over the five years.

‘Actually, though it seems intuitive, the evidence for screening for type 2 diabetes is really not strong,’ said lead author Dr. William Herman. He added that the timing of the diagnosis and the start of treatment appeared more important than the actual intensity of treatment.

‘The ideal study to look at screening for diabetes would be to screen a large population, diagnose and treat half, and to not tell the other half that they have diabetes and follow them over time and compare outcomes. Of course that study would be ethically unacceptable,’ Herman explained.

The US Preventive Services Task Force (USPSTF), a government backed panel on preventive healthcare, recently proposed an updated recommendation to screen people for abnormal blood sugar and type 2 diabetes if they are at an increased risk. That includes anyone age 45 and older.

However, Richard Kahn of the University of the North Carolina School of Medicine disagrees with the findings of the computer model research and said that it may not reflect actual biology or the way diabetes progresses for all people.

Kahn has also researched the potential benefit of earlier screening for diabetes and said that he would be hard pressed to believe the three years makes a big difference. ‘Appropriate therapy must begin at diabetes diagnosis, but the exact point when screening happens is less important,’ he said, adding that more screening earlier in life would be costly and may not have enough benefit to outweigh the cost.


The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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