Abstract
BackgroundTo assess the feasibility and uptake of a diabetes screening programme; to examine the effects of invitation to diabetes screening on anxiety, self-rated health and illness perceptions.MethodsRandomised controlled trial in two general practices in Cambridgeshire. Individuals aged 40–69 without known diabetes were identified as being at high risk of having undiagnosed type 2 diabetes using patient records and a validated risk score (n = 1,280). 355 individuals were randomised in a 2 to 1 ratio into non-invited (n = 238) and invited (n = 116) groups. A stepwise screening programme confirmed the presence or absence of diabetes. Six weeks after the last contact (either test or invitation), a questionnaire was sent to all participants, including non-attenders and those who were not originally invited. Outcome measures included attendance, anxiety (short-form Spielberger State Anxiety Inventory-STAI), self-rated health and diabetes illness perceptions.Results95 people (82% of those invited) attended for the initial capillary blood test. Six individuals were diagnosed with diabetes. Invited participants were more anxious than those not invited (37.6 vs. 34.1 STAI, p-value = 0.015), and those diagnosed with diabetes were considerably more anxious than those classified free of diabetes (46.7 vs. 37.0 STAI, p-value = 0.031). Non-attenders had a higher mean treatment control sub-scale (3.87 vs. 3.56, p-value = 0.016) and a lower mean emotional representation sub-scale (1.81 vs. 2.68, p-value = 0.001) than attenders. No differences in the other five illness perception sub-scales or self-rated health were found.ConclusionScreening for type 2 diabetes in primary care is feasible but may be associated with higher levels of short-term anxiety among invited compared with non-invited participants.Trial registrationISRCTN99175498
Highlights
To assess the feasibility and uptake of a diabetes screening programme; to examine the effects of invitation to diabetes screening on anxiety, self-rated health and illness perceptions
This study reports results from an individually randomised controlled trial undertaken during the pilot phase of the ADDITION trial of a stepwise screening programme for diabetes [10] (NCT 00237549)
This paper describes the first individually-randomised controlled trial to assess the psychological impact of screening for diabetes at six weeks
Summary
To assess the feasibility and uptake of a diabetes screening programme; to examine the effects of invitation to diabetes screening on anxiety, self-rated health and illness perceptions. Type 2 diabetes meets many of the criteria for suitability for screening It is increasingly common and creates a substantial burden of suffering and health service use [1]. It is important to quantify adverse effects of screening at the population level prior to initiation of a programme [3]. Such adverse effects are rarely assessed using randomised trial designs. Descriptions of screening programmes for diabetes have highlighted possible harmful effects of misdiagnosis among screened individuals [4], negative attitudes among patients diagnosed through screening [5] and a small reduction in perceived health after a false positive result in a screening test for gestational diabetes [6]. In a recent large controlled trial which compared screened and unscreened individuals, the few significant differences were not considered clinically important [9]
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