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 :
●The disorder is an important public health problem
- Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care 2009; 32:287.
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes Care 2017; 40:S11.
- Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362:1090.
- http://www.worlddiabetesfoundation.org/composite-35.htm (Accessed on June 19, 2012).
- Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289:76.
- Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005; 28:2668.
- Tunceli K, Bradley CJ, Nerenz D, et al. The impact of diabetes on employment and work productivity. Diabetes Care 2005; 28:2662.
- Wilson JM, Junger G. Principles and Practice of Screening for Disease. Geneva, World Health Organization, 1968.
- Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (author's transl)]. Diabete Metab 1977; 3:97.
- Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (2nd part) (author's transl)]. Diabete Metab 1977; 3:173.
- Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author's transl)]. Diabete Metab 1977; 3:245.
- International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32:1327.
- Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977.
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837.
- Schellenberg ES, Dryden DM, Vandermeer B, et al. Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med 2013; 159:543.
- Perreault L, Pan Q, Mather KJ, et al. Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study. Lancet 2012; 379:2243.
- Blunt BA, Barrett-Connor E, Wingard DL. Evaluation of fasting plasma glucose as screening test for NIDDM in older adults. Rancho Bernardo Study. Diabetes Care 1991; 14:989.
- Kramer CK, Araneta MR, Barrett-Connor E. A1C and diabetes diagnosis: The Rancho Bernardo Study. Diabetes Care 2010; 33:101.
- American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care 2010; 33 Suppl 1:S11.
- Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160.
- American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 Suppl 1:S62.
- Andersson DK, Lundblad E, Svärdsudd K. A model for early diagnosis of type 2 diabetes mellitus in primary health care. Diabet Med 1993; 10:167.
- Calado J, Loeffler J, Sakallioglu O, et al. Familial renal glucosuria: SLC5A2 mutation analysis and evidence of salt-wasting. Kidney Int 2006; 69:852.
- Herman WH, Smith PJ, Thompson TJ, et al. A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes. Diabetes Care 1995; 18:382.
- Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care 2003; 26:725.
- Glümer C, Carstensen B, Sandbaek A, et al. A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care 2004; 27:727.
- Heikes KE, Eddy DM, Arondekar B, Schlessinger L. Diabetes Risk Calculator: a simple tool for detecting undiagnosed diabetes and pre-diabetes. Diabetes Care 2008; 31:1040.
- Bang H, Edwards AM, Bomback AS, et al. Development and validation of a patient self-assessment score for diabetes risk. Ann Intern Med 2009; 151:775.
- Buijsse B, Simmons RK, Griffin SJ, Schulze MB. Risk assessment tools for identifying individuals at risk of developing type 2 diabetes. Epidemiol Rev 2011; 33:46.
- Selph S, Dana T, Blazina I, et al. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162:765.
- Simmons RK, Echouffo-Tcheugui JB, Sharp SJ, et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet 2012; 380:1741.
- Kahn R, Alperin P, Eddy D, et al. Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. Lancet 2010; 375:1365.
- Hoerger TJ, Harris R, Hicks KA, et al. Screening for type 2 diabetes mellitus: a cost-effectiveness analysis. Ann Intern Med 2004; 140:689.
- Gillies CL, Lambert PC, Abrams KR, et al. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. BMJ 2008; 336:1180.
- Siu AL, U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015; 163:861.
- Canadian Task Force on Preventive Health Care, Pottie K, Jaramillo A, et al. Recommendations on screening for type 2 diabetes in adults. CMAJ 2012; 184:1687.
- PH38 Preventing type 2 diabetes - risk identification and interventions for individuals at high risk: guidance. http://guidance.nice.org.uk/PH38/Guidance/pdf/English (Accessed on October 30, 2013).
- 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 (NICE)
- A SUGGESTED APPROACH
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS