Tackling the global diabetes burden: will screening help?

Abstract

Worldwide, cases of type 2 diabetes have doubled from nearly 150 million in 1980 to almost 350 million today, 1 Danaei G Finucane MM Lu Y et al. on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose)National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet. 2011; 378: 31-40 Summary Full Text Full Text PDF PubMed Scopus (2648) Google Scholar and effective strategies to reduce the burden of disease are greatly needed. A large and highly variable proportion of cases are undiagnosed, 2 Yang W Lu J Weng J et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010; 362: 1090-1101 Crossref PubMed Scopus (2631) Google Scholar and in view of the available evidence-based treatments, 3 Simmons RK Echouffo-Tcheugui JB Griffin SJ Screening for type 2 diabetes: an update of the evidence. Diabetes Obes Metab. 2010; 12: 838-844 Crossref PubMed Scopus (35) Google Scholar early detection through diabetes screening is worth careful consideration. Diabetes screening and diagnosis can be done with relative ease, which further escalates popular support for wide-scale screening. However, these compelling arguments overlook the screening costs, potential harms, and lack of clear evidence that screening improves health outcomes compared with current routine clinical diagnosis. In The Lancet, Rebecca Simmons and colleagues 4 Simmons RK Echouffo-Tcheugui JB Sharp SJ et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet. 2012; (published online Oct 4.)http://dx.doi.org/10.1016/S0140-6736(12)61422-6 PubMed Google Scholar report their findings from the ADDITION study, the most earnest attempt to date to try to settle the diabetes screening quandary. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trialIn this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefits of screening might be smaller than expected and restricted to individuals with detectable disease. Full-Text PDF Open AccessDiabetes and endocrinology: a call for papersThe 20th century saw an increased understanding and dissemination of information on disorders affecting metabolism and endocrine function. A debate on the nomenclature—including use of “the indefensible word ‘endocrine’”—took place within the pages of The Lancet in 1917.1–4 Nearly 100 years on, much progress has been made, and endocrine and metabolic disorders have come together in a diverse and colourful specialty, encompassing a variety of conditions affecting all parts of the body. Disorders of hormone secretion are indiscriminate in adversely affecting health and wellbeing by targeting reproduction, homoeostasis, metabolism, growth, and development. Full-Text PDF