Study: Screen and Treat Policies Ineffective For Preventing Type 2 Diabetes
A recent study found that screen and treat policies do not accurately predict the onset of diabetes in at-risk patients, and may result in misdiagnosis and treatment.
For their study, the researchers located empirical studies evaluating the accuracy of tests that identify prediabetes on Medline, PreMedline, and Embase, and performed 2 meta-analysis on the data to assess the accuracy of oral glucose tolerance tests used to screen for prediabetes, and to assess the risk of progression from prediabetes to type 2 diabetes after lifestyle or metformin interventions. Overall, their meta-analysis included 49 studies examining the effectiveness of screening tests, and 50 studies examining the effectiveness of intervention trials.
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Their analysis showed that HbA1c had a mean sensitivity of .49, and specificity of .79 for identifying prediabetes, and fasting plasma glucose had a mean sensitivity of .25 and a specificity of .94. According to their findings, the accuracy of HbA1c to detect prediabetes is not sensitive or specific, and the fasting glucose test is specific but not sensitive. The low sensitivity of the diagnostic tests resulted in more false negative diagnoses in patients.
According to the researchers, the inaccuracy of screening methods for prediabetes resulted in a large number of patients receiving an incorrect diagnosis. The interventions for people diagnosed with prediabetes used to delay or prevent type 2 diabetes were determined to have some efficacy.
“These findings suggest that “screen and treat” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes,” the researchers concluded.
—Melissa Weiss
Reference:
Barry E, Roberts S, Oke J, Vijayaraghavan S, Normansell R, Greenhalgh T. Efficacy and effectiveness of screen and treat politics in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions [published online January 4, 2017]. BMJ. doi: http://dx.doi.org/10.1136/bmj.i6538.