Preventing Type 2 Diabetes with "Screen & Treat" Seen as Inadequate

By Joe Elia

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

National approaches to screening patients at risk for type 2 diabetes and treating to delay or prevent the condition are far from satisfactory, according to a BMJ meta-analysis.

Based on their review of 100 studies, the authors conclude that the usual screening instruments for prediabetes are inadequate. Hemoglobin A1c (sensitivity of about 50% and specificity of about 80%) and fasting glucose (25% and 94%, respectively) risk missing or overdiagnosing the condition. Interventions such as lifestyle changes and metformin, which generally had adherence rates under 30%, have modest effects, but the quality of the studies was "often low."

An editorialist agrees with the authors that the solution to the type 2 diabetes problem may lie "upstream" of diagnosis and treatment — that is, for example, by "making diet versions of soft drinks cheaper than sugary versions, and interventions to make physical activity easier or safer such as cycle lanes separate from traffic."