Major benefits are likely to accrue from early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure and cholesterol treatment after diagnosis is less important than the time of initiation. Screening for type 2 diabetes is warranted to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multi-factorial treatment.
Only 20% of those with undiagnosed diabetes were identified by screening in Denmark. For each person with diabetes identified, another two at high risk of diabetes and six at high risk of cardiovascular disease were identified. Screening for diabetes had limited short- and long-term adverse psychological impact on participants. Cardiovascular risk factors (weight, blood pressure and cholesterol), including health-related behaviours (smoking), substantially improved the following detection of diabetes by screening. Small increases in treatment intensity of screen-detected patients were associated with a non-significant 17% reduction in risk of a first cardiovascular event. Among people with screen-detected diabetes, all-cause mortality over 7 years was twice as high for those with HbA1c <6.0% compared with those with HbA1c ≥6.5% at screening. Those with HbA1c <6.0% were less intensively treated than those with HbA1c ≥6.5%. The all‑cause mortality in the latter group was not significantly different from people with normal glucose tolerance and HbA1c <6.0% at screening, presumably due to more intensive treatment. At population level, invitation of high-risk individuals to screening was not associated with a reduction in all-cause or diabetes-related mortality over 10 years. The ADDITION study provides further evidence of the net benefit associated with earlier detection and treatment of type 2 diabetes. Rather than screening the population for diabetes, primary care teams should focus their efforts on earlier detection and treatment of risk factors among those at high risk of diabetes and high risk of cardiovascular disease.
An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death.