Prevention Of Type Diabetes Implications For Screening

Screening for diabetes may be appropriate under certain circumstances because early detection and prompt treatment may reduce the burden of type 2 diabetes and its complications. However, widespread screening for asymptomatic individuals for type 2 diabetes cannot be recommended. Screening may be appropriate if the subjects have one or more of the risk factors listed in Table 4.

The rationale for screening of type 2 diabetes must be based on the presence of factors having a significant effect on the risk of developing diabetes. Second, screening for diabetes is rational only if diabetes can be prevented by normalizing modifiable risk factors. Clinical trials have demonstrated the efficacy of lifestyle-intervention programs in the prevention of type 2 diabetes. Da Qing study from China (47) showed that exercise and diet resulted in a decrease of 42% to 46% an incidence of type 2 diabetes among 577 subjects with IGT. The Finnish Diabetes Prevention Program demonstrated that weight loss and regular exercise reduced the incidence of type 2 diabetes by 58% (48), and this preventive effect was observed even 3 years after the stopping the intervention (49). Similarly, the Diabetes Prevention Study in the United States showed that diet and regular exercise reduced the incidence of type 2 diabetes by 58% among 3234 subjects with IGT (50). Lifestyle intervention works as well in men and women and in all ethnic groups. Lifestyle was also effective in the Japanese (51) and Indian (52) trials. Accumulating evidence implies that lifestyle intervention is highly successful and screening should be targeted to subjects with high risk of developing diabetes.

The ADA has recommended the plasma fasting glucose measurements as a screening test because it is easier and faster to perform, more convenient and acceptable to patients, and less expensive (53). In contrast, the WHO criteria for diabetes still include a 2-h oral glucose tolerance test, which might be used in the screening of high-risk individuals. Recent studies indicating that 2-h glucose identifies better than fasting glucose values individuals with high risk of cardiovascular disease favors the use of a 2-h oral glucose tolerance test. However, the 2-h glucose tolerance test has the high within-test variability up to 25%. According to different studies when subjects were retested after an interval of up to 3 months 35% to 75% of the subjects who were IGT an the first test had reverted to normal when retested (54).

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