Screening for Prediabetes and Type 2 Diabetes: Updated Evidence Report and Systematic Review for the US Preventive...

Area of Science:

• Endocrinology and Metabolic Diseases
• Preventive Medicine
• Public Health

Background:

• Type 2 diabetes is a prevalent condition contributing significantly to morbidity and disability.
• Effective screening strategies and interventions are crucial for managing prediabetes and diabetes.

Purpose of the Study:

• To synthesize evidence on screening for prediabetes and diabetes.
• To inform the US Preventive Services Task Force (USPSTF) recommendations.

Main Methods:

• Systematic review of controlled studies on screening and interventions for prediabetes/diabetes.
• Literature search through September 2019, with surveillance through May 2021.
• Dual review, qualitative synthesis, and meta-analyses of 89 publications (68,882 participants).

Main Results:

• Diabetes screening trials showed no significant mortality benefit or clear evidence of harms.
• For recently diagnosed diabetes, intensive glucose control (sulfonylureas, insulin, metformin) improved health outcomes.
• Lifestyle interventions for prediabetes reduced diabetes incidence (pooled RR, 0.78) and improved intermediate outcomes (weight, BMI, blood pressure).
• Metformin also significantly reduced diabetes incidence (pooled RR, 0.73) and aided weight management.

Conclusions:

• Diabetes screening lacks demonstrated mortality benefits, with limited data on other outcomes and harms.
• Interventions for diagnosed diabetes and prediabetes are effective in improving health outcomes and reducing disease incidence.