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Am Fam Physician. 2013;87(7):510

Clinical Question

Are high-risk patients who are screened for diabetes mellitus better off than patients who are diagnosed through the usual means?

Bottom Line

Screening high-risk patients for diabetes provides no 10-year mortality benefit. The findings of this study are consistent with those of another large study of screening for type 2 diabetes (http://www.essentialevidenceplus.com/content/poem/130943 [subscription required]). Perhaps it is time to stop screening patients for diabetes and use our limited resources on endeavors that make a difference, like smoking cessation. (Level of Evidence = 1b)

Reference

SimmonsRKEchouffo-TcheuguiJBSharpSJet alScreening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet.2012; 380( 9855): 1741– 1748.

Study design: Other

Funding source: Foundation Allocation: Uncertain

Allocation: Uncertain

Setting: Outpatient (primary care)

Synopsis

These British researchers conducted a cluster randomized trial of screening for type 2 diabetes. Fifteen general practices were to screen and intensively treat adults with diabetes, 13 practices were to screen and treat patients according to national guidelines, and five practices were left to their own devices. One practice dropped out before screening commenced. Overall, more than 20,000 high-risk adults 40 to 69 years of age were included and followed for an average of 10 years. The authors used national databases to determine if any of the patients had died during the study period. Among the screening practices, 94 percent of potentially eligible patients were invited to participate, 75 percent were screened, and 3 percent were found to have diabetes. The overall death rate in the group of screened patients was 10.5 (per 1,000 person-years) compared with 9.9 in unscreened patients. Additionally, there were no differences in cardiovascular deaths (3.3 and 3.2, respectively) or cancer-related deaths (4.8 and 4.4, respectively).

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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