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Last Updated: 1/16/2014  

Screening for Type 2 Diabetes

  • Know that no direct evidence exists showing that screening for type 2 diabetes improves health outcomes or mortality rates.

  • Screen all adults with CVD, hypertension, dyslipidemia, or other CVD risk factors for diabetes.

  • Understand that there is insufficient evidence for diabetes screening in adults without CVD risk factors.

  • Consider screening for diabetes in adults 18 years or older with risk factors for type 2 diabetes (family history, obesity, gestational diabetes, polycystic ovarian syndrome, high-risk ethnic group).

  • Recognize that although there is no direct evidence about screening intervals, expert panels have recommended screening every 3 years.

  • Use the FBG test to screen for diabetes because it is easier to administer, is less costly, and is more reproducible than the 75-g OGTT to detect diabetes; consider using HbA1c to screen for diabetes

  • Consider performing a 75-g OGTT in individuals with an FBG of 100 to 126 mg/dL (5.6 to 7.0 mmol/L), as diabetes cannot be adequately confirmed or excluded with FBG values within that range.

  • Appreciate that the HbA1c test has good specificity but only moderate sensitivity to diagnose diabetes.

  • Appreciate that intensive glycemic control in persons with type 2 diabetes reduces intermediate markers of microvascular complications, but it has not been convincingly shown to reduce end-organ complications or macrovascular disease.

  • Be aware that treatment of overweight diabetes patients with metformin reduces CVD events, diabetes-related complications, and mortality rate.

  • Recognize that treatment of hypertension and dyslipidemia in persons with diabetes reduces the risk of CVD events and mortality to a greater extent than in those without diabetes, partly due to their higher baseline risk for CVD, and because treatment is effective at lower levels of BP and LDL cholesterol in patients with diabetes.

  • Recognize that ASA treatment reduces cardiovascular events in type 2 diabetes patients with CVD.

DOI: 10.7326/s370
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Denice Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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