Should there be a national diabetes screening programme?

What makes a good screening programme?

First, the condition being screened for needs to be an important health problem and the natural history of the disease needs to be sufficiently well understood so that we can be confident of intervening at a sufficiently early stage to meaningfully improve the outcome.

Diabetes? Yes, it gets a big tick.

Second, the test should be safe with low risk of morbidity and should be widely acceptable and available.

Fasting plasma glucose or HbA1c? Another tick.

Third, the intervention administered upon detection of a positive result needs to be of proven efficacy, with evidence that early intervention improves prognosis. Diabetes – surely that’s another decent tick?

Finally, the screening programme itself. There should be good quality evidence from RCTs that the screening programme itself is effective in reducing morbidity and mortality, and that it is cost effective.

This could be where diabetes fell down last time a national screening programme was looked at in 2006? I’m not sure, although it is interesting to note that a Lancet paper in 2012 by Dr Simon Griffin et al detected no reduction in mortality after a decade of follow up from a population-based diabetes screening programme in the East of England.

It concluded that "the benefits of screening might be smaller than expected and restricted to individuals with detectable disease".

However, I am pleased to hear that the national screening committee is about to re-examine the question and report its findings in the autumn.

Since they last reported, we’ve had the national vascular risk screening programme for adults over 40 implemented which in itself is a partial diabetes screening programme. I suspect the chances of a positive outcome this time are high and it would be good news for the estimated three quarters of a million people in the UK today with undiagnosed diabetes -  a number only set to grow as the population ages and the mean BMI remorselessly rises.

Tags for this article: prevention, screening

The author - Dr Jeremy Turner

Jeremy Turner A consultant diabetologist and endocrinologist in Norfolk, and author of Diabetes Bible

A bit more about the blog...

My blog expresses my personal views on the rapidly advancing field of diabetes. It is aimed at fellow physicians and is not offering medical advice to readers. I will not respond to requests for clinical advice. If you have health concerns please contact your GP or specialist.

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