Do people who have Diabetes Mellitus Type 2 detected by screening tests do better than people who have Diabetes discovered when they present with symptoms? Conventional wisdom says screening detects Diabetes earlier and patients should have better outcomes. A study which compared people detected by screening vs people who had their diabetes detected when presenting with symptoms does not support this. Screening was based on family history of diabetes, a personal history of heart disease or gestational diabetes, obesity, hypertension, or high cholesterol. All patients were given similar treatment after detection. At baseline, patients presenting with symptoms had higher sugars and A1Cs while the people presenting for screening had more cardiovascular disease, kidney disease, and higher blood pressure. No difference in endpoints was noted, leading the authors to recommend more studies to validate these findings and possibly recommend against screening. DSK comments. I have provided the source for this study so you can see for yourself. My interpretation of the study invalidates any results as the people were chosen to be screened based on the presence of cardiovascular risk factors, ie obesity, hypertension, high cholesterol or heart disease. While they had the advantage having the Diabetes treatment start in an earlier stage of the disease,the benefit was cancelled out by pre-selecting people with a higher risk of heart disease. When setting up a study to answer a specific question, the populations at baseline should not be so different. I would have preferred a study in which people were selected for screening at random, and then offered the same standard of treatment as the people presenting with symptoms. What do you think? Please comment below.
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Alan, you are right that it does not matter if a disease is discovered early if the treatment is not effective. There are many factors that increase cardiovascular risk including lipid profile, and blood pressure and the benefit on macro-vascular disease (heart attacks and strokes) of correcting these two is actually greater than lowering the sugar. Treatment of type 2 Diabetes is a joint effort by both doctor an patient and the emphasis should be on lifestyle. I have seen patients where the emphasis was on the blood sugar and correction was made attempted without adequate adjustment of the diet. If the patient was not advised to change diet or did not follow medical advice, the result would be the same. If he or she continued to overeat and then take drugs or insulin to get the sugar down, the result would not be satisfactory. The diet needs to be individualized to achieve appropriate goals and the medications and or insulin should be matched to it. The article does not provide adequate information about what standards were used to threat each patient. I agree with you. Thank you so much for visiting our website and for the insightful comment.
Hi Sharon, thank you so much for visiting out website. Common sense suggests that picking up a disease state in its early form and treating it would provide much better results than waiting for the disease to progress to the point in which the patient has symptoms. I have participated in many screening programs and have detected people who had diabetes type II and did not know it because it was too early to cause symptoms. It was my clinical impression that patients who had the advantage of early detection did better. As long as there is affective treatment, screening should be of benefit. I have found many statements that defied logic or lacked proper data, or studies I felt were flawed on the internet. I presented this study to encourage critical thinking of all studies whether on the internet or from another source. I presented this study to my diabetes group, called diabetes mastermind. I invite you to join our group, see all the discussion of our members on this and other topics and participate. Let me know if there is any way I may serve you. Sybil
Dr. Kramer,
I have been a diabetic for 35-40 years. I discovered my problem
using knowledge of the disease process. My family has a long
history of diabetes. I went to the drugstore and bought keto-sticks.
I was experiencing classic weight loss, thirst, and infection. The
infection was DX’s a week before without a blood sugar test.
I ran the keto-stick and it was positive. I went to my Doctor’s
office and took the results with immediate treatment.
Now, that is one way to DX’s the illness. Kudo’s to me.
I feel screening tests are important as well as presenting with
symptoms. I don’t have the research to back my idea. On the
other hand, I been diabetic 35-40 years. ! It will be interesting
to see the outcome of the research.
What do you think?
“All patients were given similar treatment after detection”, or, in the words of the abstract: “Subsequent diabetes care followed the same standard for both groups, although glycemic control was better (6.8% versus 7.1%, P=0.001) and insulin use lower in the screening group (5% versus 13%, P=0.002).
After a mean follow-up of about 7 years and adjustment for other factors, the primary composite endpoint showed no difference (adjusted hazard ratio 0.67, 95% confidence interval 0.36 to 1.25).”
Therein lies the problem. It matters little whether people are discovered early on screening if the treatment given is inappropriate or ineffective.
Unfortunately, in my lay experience, the traditional dietary advice given to new type 2 diabetics is more likely to exacerbate the condition than to improve it. That leads to excessive prescription of meds and insulin to combat the lifestyle changes rather than complement them.