The Worth of Diabetes Screening Programs

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11 i ~ 5showing that for every known diabetic there existed another person with unrecognized diabetes (i). Promotional activities of the now defunct Diabetes Control Program of the U.S. Public Health Service, and its successor organizations, were instrumental in initiating nationwide, large-scale detection programs and spearheaded the conversion from the then current urine tests to bloodbased methodology. The advent of automated chemistries expanded the feasibility and acceptability of these programs. The American Diabetes Association subsequently endorsed blood glucose screening programs, and they became the major activity of local community diabetes organizations. These programs had definite value in uncovering new cases of diabetes, but many negative aspects also emerged. Inadequately organized programs resulted in situations where individuals with gross hyperglycemia were occasionally lost in a numbers game, the delayed referral evoking much professional and participant criticism. Conversely, evangelistic lay groups were often thrust into the position of inappropriately suggesting a diagnosis of diabetes on the basis of a single blood test. Moreover, because the yield of confirmed new cases of diabetes among positive screenees was low, the vast majority of screenees had the burden of needless anxiety, inconvenience, and expense of diagnostic evaluations. Also, the therapeutic value of identifying new diabetics at such an early stage of the condition was questioned. Indeed, the label "diabetes" itself led to many problems. The costs of periodic evaluations, the side effects of oral hypoglycemic agents when inappropriately employed, and the effects on employability and insurability all added a formidable set of liabilities to diabetes screening programs. Furthermore, recent changes in diagnostic standards embarrassingly "undiagnosed" many new cases of diabetes identified by such programs. Not surprisingly, then, organized