Should we still screen for type 2 diabetes after ADDITION-Cambridge? A low-income world perspective

The worldwide growing epidemic of diabetes is driven by the increase in type 2 diabetes. The very insidious natural history of type 2 diabetes and the availability of simple means to detect it as well as its preceding silent stages make type 2 diabetes and ideal disease for screening. Although public policies for type 2 diabetes screening do exist in many developed countries, issues related to its benefits on disease outcomes and its cost-effectiveness have been a concern. Recent results from the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge show that screening for type 2 diabetes is not associated with a reduction in mortality, either all-cause, cardiovascular or diabetes-related, after 10 years of follow-up. It seems crucial to raise the awareness of the medical community on the high risk of misinterpretation of these results as the death knell of type 2 diabetes screening. To that end, we discuss here some potential explanations of the lack of benefit, and we suggest a cautious uptake of the results, especially in low-income countries where type 2 diabetes screening is by far more likely to yield substantial health benefits.