SCREENING FOR TYPE 2 DIABETES
Principles that guide the decision to use screening procedures in asymptomatic people include the following:1. Discovery of a disease that represents an important health problem and imposes a significant burden on the population.2. An understanding of the natural history of the disease.3. Recognition of a preclinical, asymptomatic stage at which the disease may be diagnosed.4. Acceptable and reliable tests to detect the preclinical stage of the disease.5. Evidence that treatment after early detection yields benefits superior to those obtained when treatment is delayed.6. Reasonable costs of case finding and treatment, balanced in relation to overall health expenditures, facilities, and resources to treat newly diagnosed cases.7. Continuation of a systematic ongoing process, not merely an isolated effort.For diabetes, conditions 1-4 are met. Successful screening in an outpatient clinic has been shown. Two recent reports have shown that the time of onset of diabetes can be delayed by intensive lifestyle modification or metformin therapy. These studies suggest that condition 5 is met. Evidence is less convincing, however, that screening is cost effective or is carried out as a systematic, ongoing process in most environments. Accordingly, the ADA has recommended that screening of high-risk individuals be considered by health care providers at 3-year intervals, beginning at age 45.If multiple risk factors are present, screening should be carried out at a younger age and more frequently. In high-risk children, screening should be done every 2 years, starting at age 10 (or at puberty, if it occurs at a younger age). Recent studies indicate that these guidelines should be adjusted to include screening under the age of 10 in obese children. Among 55 obese children referred to a pediatric obesity clinic, 25% of those aged 4-10 had IGT. Of 112 obese adolescents (ages 11-18 years), 21% had IGT and 4% had undiagnosed diabetes.*18\357\8*
