Screening for Type 2 Diabetes and Dysglycemia

Abstract

Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

“…The model was based on a systems approach suggested by World Health Organization (WHO), with five interacting dimensions influencing adherence: Social and economic factors; Health care team and system related factors; Conditionrelated factors; Patient-related factors; and therapy-related factors [19]. The WHO model was combined with Pharmaceutical Care models and theories focusing on therapy outcomes monitoring and patient empowerment leading to better self-management and adherence [20][21][22]. The model "Safe and effective use of medicines" was developed for implementation in primary care [16].…”

Type 2 Diabetes Prevention Programs; How Far are we?

“…The cost-effectiveness of lifestyle interventions has been examined in a number of clinical trials and computer modelling simulations. Although pharmacological interventions have also been shown to prevent diabetes, the cost effectiveness and risk-benefit ratio are less clear [32][33][34][53][54][55][56][57][58][59][60][61][62][63].…”

“…The cost effectiveness of a policy of universal screening for undiagnosed T2D alone, which offered no intervention to those with IGT, is still uncertain, since its high cost effectiveness ratio was primarily attributable to the small gain in health benefit [60][61][62][63]69,[70][71][72][73][74][75][76][77].…”

Diabetes prevention: global health policy and perspectives from the ground

“…Advantages of the FPG include its ease and inexpensiveness with universally available automated instruments. Similarly, OGTT serves as another option for diagnosing prediabetes, the 2-h glucose level being a better predictor of cardiovascular morbidity and mortality than the FPG [21,22]. Nevertheless, both glucosebased measurements are subject to methodological limitations, particularly in terms of biologic and analytic variability.…”

“…Nevertheless, both glucosebased measurements are subject to methodological limitations, particularly in terms of biologic and analytic variability. Moreover, OGTT (which is time consuming and expensive) has relatively poor reproducibility [21,22].…”