Back to Wilson and Jungner: 10 Good Reasons to Screen for Type 2 Diabetes Mellitus

Abstract

The US Preventive Services Task Force (USPSTF) operates under the Agency for Healthcare Research and Quality, one of 11 divisions of the US Department of Health and Human Services. A panel of preventive medicine and health care experts, the USPSTF reviews existing literature and evidence to make recommendations regarding preventive care measures.1 Primary care practitioners rely on such guidelines to make medical decisions, and insurance companies and government agencies use this information to determine payment for services rendered and for credentialing of institutions. Recently, the USPSTF updated its guidelines on screening adults for type 2 diabetes mellitus2,3 (Table 1).4 This report was based on a literature review of the existing data in both MEDLINE and the Cochrane Library databases. Members of the USPSTF concluded that screening for diabetes in asymptomatic individuals with hypertension (blood pressure >135/80 mm Hg) was merited. Unfortunately, they did not recommend or highlight the importance of screening other at-risk populations who would be screened under the American Diabetes Association (ADA) guidelines, citing lack of direct or indirect evidence supporting population screening.2 However, the authors acknowledge that direct evidence, such as a randomized trial that compared treated vs untreated persons in whom screening detected diabetes, will not be available because “withholding treatment from persons with known diabetes is unethical….” The ADA also concluded that a study of this type is unlikely to occur and developed guidelines based on existing data and expert opinion that recommend screening for diabetes mellitus in a much wider population because of the epidemic in the United States.4 TABLE 1. ADA and USPSTF Criteria to Screen for Diabetes Mellitusa In addition, the criteria used to develop these new USPSTF recommendations have been a subject of interest. Although USPSTF states its guidelines are based on explicit criteria,1 experts have questioned its more restrictive screening criteria used to develop its diabetes screening guidelines compared with that used for another chronic disease, obesity.5 This query has merit considering the impact USPSTF guidelines have on population health. Clearly, screening for disease must meet certain criteria to be medically and financially acceptable. Perhaps the most recognized criteria were determined by Wilson and Jungner6 in 1968. These principles (Table 2), which the World Health Organization follows, define the basis of preventive medicine 40 years later and are largely considered the standards by which screening tests are judged and determined. TABLE 2. Wilson and Jungner Criteria for Disease Screening (Adopted by the World Health Organization) Because of the potential far-reaching implications of the new USPSTF guidelines, it is important to examine the merits of diabetes screening using the 10 criteria of Wilson and Jungner since national screening recommendations profoundly affect health care delivery and outcomes.