The growing importance of diabetes screening.

Abstract

Aclassic report by T. Franklin Williams et al. (1) in 1967 documented glaring deficiencies in diabetes care that went largely uncorrected for the next 30 years. It is only in the last 10 years that we have seen substantial and sustained improvement in basic aspects of care such as glycemic control, blood pressure control, and lipid control (2). Since 1995, there have been substantial and sustained improvements in glucose, blood pressure, and lipid control in adults with diabetes, and in some reports from medical groups, A1C is now <7.0%, mean SBP <128 mmHg, and mean LDL <90 mg/dl (3). The increased likelihood that those with diabetes will receive adequate treatment increases the importance of early detention of diabetes through screening for diabetes and pre-diabetes. However, in the last decade sobering data have also emerged that indicate that more intensive control is not necessarily better. The hope that normalization of glucose in those with diabetes would virtually abolish the increased cardiovascular risk associated with type 2 diabetes is vanishing. Rather than confirm expected benefits, recent trials instead provide a most unwelcome quantification of the risks of intensive glycemic control, including high treatment costs, increased risk of severe hypoglycemia, substantial weight gain, and even, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, an increased risk of death (4–6). These sobering and unexpected data have far reaching implications that will take years to appreciate. However, it is immediately apparent that more attention needs to be devoted to primary prevention of type 2 diabetes and to early identification of cases of diabetes and its insidious progenitor, pre-diabetes. Our recent success in achieving reasonable levels of glycemic control, and emerging data that more intensive control is not necessarily better, clearly indicate the need for more effective screening for and primary …