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Recommendation
| Understand that there is fair evidence that detecting diabetes in persons with CVD, hypertension, dyslipidemia, and other CVD risk factors improves estimates of CVD risk and may increase their risk to a level worthy of interventions that have been shown to reduce CVD events in diabetes patients.
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Evidence:
- Based on Framingham data, the risk of cardiovascular events in patients with diabetes is two to three times greater than in those without diabetes, and that risk crosses the 10% threshold by age 55 in men and age 60 in women (37; 38).
- The benefits of screening for type 2 diabetes depend largely on baseline CVD risk, and the benefits may be greatest in those with a baseline 10-year CVD risk of >8% (41).
- Treatment of adults with aspirin reduces primary and secondary CVD risk by 15% to 44% (89; 124; 125; 126) (see information on ASA treatment), and statin therapy reduces primary and secondary CVD risk by 25% to 30% (108; 109; 110; 111; 112; 113; 114; 121) (see information on lipid-lowering treatment).
- Aggressive BP control of hypertensive patients reduces CVD events by 32% to 51% (89; 90) and CVD mortality by 67% (89) in diabetes patients only (see information on BP control).
- If 90% of screened hypertensive persons with diabetes received tight BP control for 5 years, the estimated number needed to screen to prevent one CVD event would be 500 (74).
- A review of the evidence for the USPSTF on screening for type 2 diabetes found that there is a lack of direct evidence on the health benefits for screening of type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to show health benefits for screening general populations. However, persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes (134).
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Comments:
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| Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Screening for Type 2 Diabetes
> Direct Evidence that Screening Reduces Adverse Outcomes
