Screen for Diabetes Earlier for Better Outcomes
The current recommendation for screening people for Type 2 Diabetes begins at age 45. However, a new study finds that screening earlier, particularly for those who are overweight, is not only cost-effective, but can also curb future diabetic complications.
The American Diabetes Association estimates that 5.7 million Americans currently have type 2 diabetes and do not know. Another 57 million have a precursor condition called pre-diabetes. Diabetes is asymptomatic in its earliest stages, so many cases remain undiagnosed for long periods of time, leading to a greater chance for complications such as heart attack, kidney disease, nerve damage, stroke, eye problems, and infections.
The study, conducted by Dr. Richard Kahn of the University of North Carolina in Chapel Hill, used a mathematical model simulating a population of 325,000 non-diabetic 30-year-olds to compare seven screening strategies. They varied the starting times for screening between ages 30 to age 60 and included co-related diagnoses such as high blood pressure. They also evaluated none-to-minimal screening (every three to five years, for example) and maximum screening (every six months).
The researchers concluded that sequential screening for type 2 diabetes is best when started between the ages of 30 and 45 and is repeated every 3 to 5 years. For example, if screening began at age 30 and was repeated every three years, one model showed that it would prevent about seven heart attacks per 1000 people over the age of 50.
The strategies also found that earlier screening added a significant number of quality-adjusted life years (QALY’s) – about 6.3 years per person - and that beginning the screenings before symptoms arose could save between $5,000 to $15,000 per additional year of life.
"Everybody should get screened for diabetes on a regular basis between 30 and 45 years, and repeat the screen every three to five years," said Kahn. "Screening is cost-effective. It's a bargain in the world of medicine to screen and get someone into effective treatment." He suggests timing diabetes screening with cholesterol screenings to maximize cost-savings.
By 2034, about 44 million Americans will be living with diabetes, almost twice the number today, and spending for the disease will almost triple to $336 billion annually, according to a study published last year by University of Chicago researchers.
Kahn R, et al "Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effective analysis" Lancet 2010; DOI: 10.1016/S0140-6736(09)62162-0.