Screening for diabetes in general practice

The prevalence of type 2 diabetes is rising rapidly worldwide. Evidence suggests that between one third and one half of cases are undiagnosed and patients may have preclinical disease for as long as 12 years. At diagnosis, 50% of patients have microvascular complications (retinopathy, neuropathy, or nephropathy) and patients have twice the risk of macrovascular disease compared to the background population. Screening for type 2 diabetes would allow earlier recognition of cases, with the potential to intervene earlier in the disease course, but whether this would result in improved long-term outcomes is unknown. The debate continues about who should be considered for screening, how we should screen, and whether we should screen for diabetes at all. The authors review the evidence, particularly in light of the recent position statement on diabetes screening published by the American Diabetes Association. If we do start screening for diabetes, one of the major challenges ahead is to ensure resources are in place to allow optimization of treatment for the increasing number of patients. This is important both in those found to have diabetes and in those with lesser degrees of glucose intolerance who are at high risk of developing diabetes and are at increased risk of macrovascular disease.