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Studies show diabetes screenings do not reduce mortality, CVD in general population
At the population level, screening for type 2 diabetes and cardiovascular risk does not have an impact on mortality or cardiovascular disease incidence, although researchers observed screening benefits among those who were diagnosed with diabetes, according to three population-based studies conducted in Denmark and Sweden.
“Population-level screening programs for type 2 diabetes in high-income countries are not justified,” Rebecca K. Simmons, PhD, of the department of public health, section of general practice at Aarhus University, Denmark, told Endocrine Today. “Clinicians should continue to opportunistically test patients who they suspect of having diabetes or who are at high risk of diabetes, recognizing the benefits of an earlier diagnosis and treatment.”
In two studies, Simmons and colleagues analyzed data from 153,107 adults registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) who were sent a diabetes risk score questionnaire between 2001 and 2006, as well as 1,759,285 adults aged 40 to 69 years without known diabetes registered with a general practice not participating in the ADDITION study (controls). Researchers identified patients from the screening and no-screening groups who were diagnosed with diabetes between 2001 and 2009 (n = 139,075) and compared risks for CVD and mortality in these groups between 2001 and 2012.
In the screening group, 27,177 (18%) attended for screening, of whom 1,533 were diagnosed with diabetes. Between 2001 and 2009, 13,992 people were newly diagnosed with diabetes in the screening group; 125,083 were diagnosed in the no-screening group. Between 2001 and 2012, researchers observed that the risk for CVD was lower among patients with diabetes in the screening group when compared with patients with diabetes in the control group (HR = 0.84; 95% CI, 0.8-0.89), as was the risk for mortality (HR = 0.79; 95% CI, 0.74-0.84).
However, the screening program for type 2 diabetes and CV risk factors was not associated with a reduction in the rate of mortality or CV events in the overall Danish population. Over a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 deaths in the no-screening group (HR = 0.99; 95% CI, 0.96-1.02). There were 17,941 CV events in the screening group and 208,476 CV events in the no-screening group (HR = 0.99; 95% CI, 0.96-1.02).
In a third study, Adina L. Feldman, MSc, PhD, AFHEA, of the MRC Epidemiology Unit at University of Cambridge, and colleagues analyzed data from 142,037 residents participating in the Vasterbotten Intervention Program, a community-based public health program in Vasterbotten County, Sweden. Residents were invited to clinical examinations that included diabetes screening by oral glucose tolerance test at ages 30, 40, 50 and 60 years. Between 1992 and 2013, researchers identified 1,024 screening-detected cases of diabetes and 8,642 clinically detected cases using registry data (including 4,506 prior screening participants). For those with screening-detected diabetes, average age at diagnosis was, on average, 4.6 years younger when compared with those with clinically detected diabetes. Additionally, those with clinically detected diabetes had overall worse health outcomes when compared with those with screening-detected diabetes (HR for all-cause mortality = 2.07; 95% CI, 1.63-2.62), according to researchers.
“Screening does lead to an earlier diagnosis of diabetes and reduces mortality and risks of complications, in particular cardiovascular disease, but also renal disease and retinopathy, in those who are diagnosed with diabetes,” Feldman told Endocrine Today. “More research into effective treatments, including the development of effective and sustainable lifestyle behavior interventions to prevent type 2 diabetes, are needed on a population level,” Feldman said. – by Regina Schaffer
References:
Simmons RK, et al. Diabetologia. 2017;doi:10.1007/s00125-017-4323-2.
Simmons RK, et al. Diabetologia. 2017;doi:10.1007/s00125=017-4299-y.
Disclosures: Feldman reports no relevant financial disclosures. Simmons reports receiving supported from the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation, to complete some of this work.