Current recommendations suggest that screening for type 2 diabetes start at age 45, especially for those who are overweight, but new research shows cost-effective screening can begin between the ages of 30 and 45 for everyone.
When screening began between ages 30 and 45 and was repeated between every year to five years, the average cost per quality-adjusted year of life was $10 500 versus $15 509 when screening began at age 45 and was repeated every year, the study found.
"If you start screening between 30 and 45, you are really getting cost-effective screening," said study author Richard Kahn, a clinical professor of medicine at the University of North Carolina, Chapel Hill, who was with the American Diabetes Association at the time of the study.
Few symptoms in early stages
More than 23 million Americans have diabetes, according to the American Diabetes Association (ADA). Most have type 2 diabetes, which occurs when the body stops using insulin efficiently or doesn't produce enough insulin. Uncontrolled diabetes is associated with a significantly increased risk of heart disease, stroke, kidney disease, serious eye problems, infections and nerve damage, according to the ADA.
It's suspected that many people have had the disease for years by the time they're finally diagnosed because it has so few symptoms in its early stages. Other research has shown that diabetes treatments can help reduce the risk of complications, and the earlier they're started, the better.
To assess whether population-based screening could reduce complications and costs associated with diabetes, the researchers used a sophisticated computer modeling system.
"This model is a virtual replication of the world of health care, and takes into account cardiovascular and other complication risks, costs, tests, procedures, everything," said Kahn. "It's the SIM City of health care," referring to a popular computer game where people build their own virtual worlds.
Kahn and his colleagues evaluated eight simulated screening strategies for type 2 diabetes, such as beginning screening at age 30 and repeating the test every three years, or starting at age 45 and repeating the test every year, or waiting until age 60 and repeating the test every three years.
For all of the screening simulations that began between ages 30 and 45, the researchers found a cost and quality-of-life benefit.
"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."
"One of the big questions we've had is: does screening make a difference? This study shows us that screening in ages 30 to 45 will probably make a difference in number of people diagnosed with heart disease, kidney disease and other morbidities," said Dr. Rita Louard, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.
"We've come a long way in our ability to manage people with diabetes, so screening becomes more important because once people get identified, we now have better tools to get them to their goals. And, it's not only the blood sugars we're looking at. It's really about the other complications that track with the disease, like heart disease. So, we're more aggressive with blood pressure and with their lipids [cholesterol] once diabetes is identified," she explained.
Results of the study are published in the March 30 online edition of The Lancet. Study funding was provided by Novo Nordisk, Bayer Pharmaceuticals and Pfizer. These companies all produce diabetes treatments or products. However, the sponsors had no role in the design of the final study, data collection or analysis, or in the writing of the report, according to the report. - (HealthDay News, March 2010)