Screening for Diabetes: Can We Afford Not To Screen?

Chronic degenerative diseases represent the major challenge to public health in the 21st century. Having largely conquered epidemic infectious diseases, we face a future in which such diseases as diabetes and cardiovascular disease, and their underlying risk factors, predominate. Chronic degenerative diseases already cause 70% of deaths worldwide (1). Our medical care system has largely been attuned to the diagnosis and care of acute diseases, which generally cause symptoms and therefore do not require screening. On the other hand, the early stages of chronic degenerative diseases and the risk factors that presage these diseases are often clinically silent and would go undetected without screening.

Type 2 diabetes represents the archetype of a chronic degenerative disease. It has become epidemic, with fewer than 50 million cases worldwide in 1985 and more than 170 million cases today (2). Diabetes is associated with substantial morbidity and mortality because it damages the eyes, kidneys, and nerves and accelerates disease of the cardiovascular system (3). Moreover, the onset of type 2 diabetes is often insidious, without symptoms that would alert the patient or clinician. The estimated 9- to 12-year delay in diagnosis (4) is of particular concern because patients lose the opportunity to control hyperglycemia, dyslipidemia, and hypertension, which would reduce the complications of diabetes (5-7). Approximately 20% of patients with “newly” diagnosed type 2 diabetes have eye, nerve, or kidney disease at the time of diagnosis (8). In addition, cardiovascular disease, which is the cause of death in 75% of the diabetic population (9), begins to develop during the “prediabetic phase” (10). Because diabetes screening is not standard practice, these asymptomatic at-risk individuals cannot benefit from intensified treatment of blood pressure and dyslipidemia until symptoms or other circumstances …