U.S. Department of Veterans Affairs Health Services Research and Development Service.

BACKGROUND:There is controversy surrounding the issue of whether, and how, to screen adults for type 2 diabetes. Our objective was to measure the incidence of new diabetes among outpatients enrolled in a health care system, and to determine whether hemoglobin A1c (HbA1c) values would allow risk stratification for patients' likelihood of developing diabetes over 3 years.

A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.

OBJECTIVE -Diagnosis of a chronic illness can have a negative impact on patients' perception of their well-being ("labeling" effect). We sought to determine the effects of a new diagnosis of diabetes, discovered by systematic screening, on patients' health-related quality of life (HRQoL) 1 year after diagnosis.RESEARCH DESIGN AND METHODS -We performed diabetes screening at the Durham Veterans Affairs Medical Center of 1,253 outpatients, aged 45-64 years, who did not report having diabetes. Our initial screen was a serum HbA 1c measurement. All subjects with HbA 1c Ն6.0% were invited for follow-up measurement of blood pressure and fasting plasma glucose. A case of unrecognized diabetes was defined as HbA 1c Ն7.0% or fasting plasma glucose Ն7 mmol/dl. HRQoL was measured by Medical Outcomes Study Short Form 36 (SF-36) for all patients at baseline and 1 year after enrollment. Linear multivariable models were used to determine the independent effect of the new diagnosis of diabetes on HRQoL.RESULTS -Mean SF-36 Physical Component Score (PCS) for all patients was 36.2, and mean Mental Component Score (MCS) was 49.6. A total of 56 patients (4.5%) were found to have diabetes at screening. Patients found to have diabetes at screening had mean PCS of 35.6, which was not different from a mean PCS of 36.3 for those patients found not to have diabetes (P ϭ 0.67). After adjusting for baseline PCS values, PCS 1 year after screening was similar for patients with and without diabetes found at screening (P ϭ 0.95). Similarly, patients found to have diabetes at screening had mean MCS of 48.8; those found not to have diabetes had MCS of 49.6 (P ϭ 0.70). After adjusting for baseline MCS values, MCS 1 year after screening was also similar between the two groups (P ϭ 0.77).CONCLUSIONS -For patients with a new diagnosis of diabetes discovered through systematic screening, HRQoL is similar to patients found not to have diabetes. Furthermore, HRQoL scores remain stable over the year after screening. This suggests that screening for diabetes has minimal, if any, "labeling" effect with respect to HRQoL.