|
 The timing of the diagnosis and the start of treatment appeared more
important than the actual intensity of treatment, the researchers
reported online May 18 in Diabetes Care.
“Actually, though it seems intuitive, the evidence for screening for
type 2 diabetes is really not strong,” said lead author Dr. William
H. Herman of the University of Michigan in Ann Arbor.
“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,” Herman told Reuters Health by phone. “Of course
that study would be ethically unacceptable.”
The U.S. 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.
One way to try to estimate the benefit of early screening is to use
a computer model, which simulates the progression of diabetes and
its complications, resulting health problems, quality of life and
costs.
For the new estimates, Herman and his coauthors used data from a
large European study of people age 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.
The researchers used a computer model known as the Michigan Model 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.
[to top of second column] |
The USPSTF would not include a modeling study like this in its
reviews, Herman said.
Richard Kahn of the University of North Carolina School of Medicine
in Chapel Hill told Reuters Health he disagrees with the new
findings.
“We don’t know very much about the model whatsoever,” based on what
is included in the paper, said Kahn, who was previously the chief
scientific and medical officer of the American Diabetes Association.
The Michigan Model may not reflect actual biology or the way
diabetes progresses for all people, he said.
Kahn has also researched the potential benefit of earlier screening
for diabetes, and “I 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.
Instituting more screening earlier in life would be costly, and may
not have enough benefit to outweigh the cost, he said. A similar
debate has centered on mammography for younger women in recent
years.
SOURCE: http://bit.ly/1HyCNYc
Diabetes Care 2015.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
