Evidence:

• Immediate harms associated with screening tests are limited to the inconvenience and time commitment associated with testing and the discomfort and risks of venipuncture and oral glucose ingestion.
• One study of 1253 U.S. outpatients aged 45 to 64 years with no history of diabetes found that quality of life was not decreased after 1 year in patients diagnosed with diabetes through screening (71).
• There is little objective evidence regarding the psychological and social harm of screening programs. However, experts have suggested that potential adverse effects include excessive overall awareness of health, consequences of being labeled as “sick” or “at risk,” compromise of insurance opportunities, stigmatization and, in the case of a false-negative test result, false assurance of disease-free status (72; 73).
• A systematic review found that false-positive diagnoses may cause unnecessary treatment and difficulty obtaining life or health insurance (74).
• A systematic review of the harms of screening found that most studies are anecdotal. The most consistent finding was that false-negative results might have legal consequences due to loss of public confidence and concerns regarding delay in diagnosis (75).
• Use of the Diabetes Risk Calculator, which includes questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history, and exercise, had a sensitivity and specificity of 88% and 75%, respectively, for detecting undiagnosed diabetes in NHANES III. This tool was validated against the NHANES 1999-2004 dataset (76).

Comments:

• None.