Reasons to Exercise Caution When Considering a Screening Program for Type 2 Diabetes Mellitus

Abstract

Screening is defined as detection of disease in its early, treatable stages. The US Preventive Services Task Force (USPSTF) has issued a recommendation to screen for type 2 diabetes mellitus (DM) only in asymptomatic adults with blood pressure greater than 135/80 mm Hg.1 The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 DM in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. This recommendation has caused considerable consternation in the community of those who treat patients with type 2 DM. In this issue of Mayo Clinic Proceedings, Sheehy et al2 provide a rationale for implementation of a screening test and advocate a much broader screening regimen. Ideally, recommendations that influence the practice of medicine should be based on multiple randomized, controlled clinical trials. With this particular recommendation, however, both parties (ie, USPSTF and Sheehy et al) rely solely on expert opinion. When determining whether a screening test or program is worthwhile, some of the most important factors are evidence, guideline recommendations, competing priorities, and testing errors.