Screening for type 2 diabetes mellitus
- David K McCulloch, MD
David K McCulloch, MD
- Washington Permanente Medical Group
- Rodney A Hayward, MD
Rodney A Hayward, MD
- Professor of Medicine and Public Health
- University of Michigan
- Section Editors
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
Diabetes is one of the major causes of early illness and death worldwide. Type 2 diabetes affects approximately 8 percent of the United States population, with as many as 25 to 40 percent of those with diabetes undiagnosed [1,2]. Worldwide, the prevalence of type 2 diabetes is estimated at 6.4 percent in adults, varying from 3.8 to 10.2 percent by region; rates of undetected diabetes may be as high as 50 percent in some areas [3,4].
Type 2 diabetes accounts for over 90 percent of patients with diabetes. Because of the associated microvascular and macrovascular disease, diabetes accounts for almost 14 percent of United States health care expenditures, at least one-half of which are related to complications such as myocardial infarction, stroke, end-stage renal disease, retinopathy, and foot ulcers . Numerous other factors also contribute to the impact of diabetes on quality of life and economics. Diabetes is associated with a high prevalence of affective illness  and adversely impacts employment, absenteeism, and work productivity .
This topic will discuss the evidence and recommendations related to screening asymptomatic patients for type 2 diabetes mellitus. Screening pregnant women for gestational diabetes and the evaluation of patients with signs and symptoms of diabetes (polydipsia, polyuria, blurred vision, paresthesias, or unexplained weight loss) is discussed separately. Additionally, the prevention of type 2 diabetes in patients with impaired glucose tolerance (IGT) is discussed separately. (See "Diabetes mellitus in pregnancy: Screening and diagnosis" and "Clinical presentation and diagnosis of diabetes mellitus in adults" and "Prevention of type 2 diabetes mellitus".)
RATIONALE FOR SCREENING
The following five criteria define the optimal conditions for screening for any disorder :
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- RATIONALE FOR SCREENING
- SCREENING TESTS
- Blood glucose
- Hemoglobin A1C
- Urine glucose
- RISK FACTORS
- Calculating a risk score
- EFFECTIVENESS OF SCREENING
- Cost-effectiveness models
- SCREENING RECOMMENDATIONS BY EXPERT GROUPS
- American Diabetes Association
- US Preventive Services Task Force
- The Canadian Task Force on Preventive Health Care
- Centers for Disease Control and Prevention
- National Institute for Health and Care Excellence
- A SUGGESTED APPROACH
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS