Type 2-diabetes - Sundhedsstyrelsen

Conclusions
Based on the Project Group’s work it is concluded that:
General
H Type 2 diabetes is presently a widespread disease that has considerable
consequences for the patient, the health service and society. One in two
patients suffer complications to the disease at the time the diagnosis is
made. There is a latent period of several years between the time the disease
arises and its clinical diagnosis. All these conditions speak in favour of
screening for Type 2 diabetes (1b).
Technology
H Validated screening tests are available where the validity, sensitivity, specificity
and predictive value are known. Most tests only entail minimal
physical discomfort and should therefore be acceptable. All suffer from a
high degree of both false negative and false positive test results, however,
depending on what cutoffs are selected for the individual test (2b).
H At present there are no studies that have systematically assessed a screening
strategy based on case finding of individuals with a high risk of developing
diabetes using questionnaires and subsequent analysis of non-fasting blood
samples – an approach that would minimise the number of fasting blood
samples and the number of glucose tolerance tests. Neither is there literature
that has assessed the population’s reaction to these screening strategies.
Such a study is ongoing in Denmark, and the results are expected during
the course of 2004.
H Finally, there are no simple screening methods with high sensitivity
(90%) that concomitantly have an acceptable, high specificity (80%)
(1b).
H There is evidence that intensive medical treatment of raised blood glucose,
raised blood pressure and dyslipidemia as well as lifestyle changes can
improve the prognosis in patients with diabetes diagnosed on the basis of
clinical symptoms (1a).
H Extrapolation of results from studies encompassing these patients to patients
identified by screening is not unproblematic as the former patients
must be assumed to have more severe symptoms and a more serious disease
state.
H There is therefore a need for good documentation showing that screening
and subsequent early intensive treatment of patients detected by screening
reduce the risk of developing complications and reduce mortality, although
this can be assumed to be the case based on epidemiological
studies.
The patient
H Little has been reported about the ethical, psychological and psychosocial
consequences of screening as specifically related to diabetes, and decisions
about screening must therefore largely be based on extrapolation from
experience with other disease categories.
64 Type 2-diabetes. Medicinsk teknologivurdering af screening, diagnostik og behandling