Screening for Type 2 Diabetes Author: Lorraine Lipscombe, MD, FRCPC; Denice S. Feig, MD, MSc, FRCPC
Editorial changes - 2012-03-20
Author information and module status
Key Points
Population at Risk
Effectiveness/Harms of Screening Tests
Effectiveness/Harms of Early Treatment
Direct Evidence that Screening Reduces Adverse Outcomes
Timeline
Cost-Effectiveness
Patient Education
Referral/Consultation
Guidelines

Tables
References
Glossary
What's New
Patient Information
Additional Resources
Tools
Additional Resources

Clinical Information
Article
   Annals of Internal Medicine
 Development and validation of a patient self-assessment score for diabetes risk.
 Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study.
 Smoking, smoking cessation, and risk for type 2 diabetes mellitus
 Medical Clinics Versus Usual Care for Patients With Both Diabetes and Hypertension
Review
   Annals of Internal Medicine
 Behavioral Counseling to Promote Physical Activity and a Healthful Diet to Prevent Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force
Article
   Annals of Internal Medicine
 Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in U.S. Adults
Guideline
   American Diabetes Association
 Standards of medical care in diabetes—2007
 Screening for type 2 diabetes
   Annals of Internal Medicine
 Screening for type 2 diabetes mellitus in adults: recommendations and rationale
 Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement
 Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force
   Canadian Diabetes Association
 Clinical practice guidelines for the prevention and management of diabetes in Canada: screening and prevention
   Canadian Task Force on Preventive Medicine
 Screening for diabetes mellitus in the non-pregnant adult
   U.S. Preventive Services Task Force
 Screening for type 2 diabetes mellitus in adults
Article
   American Journal of Obstetrics and Gynecology
 Screening for gestational diabetes: different cut-offs for different ethnicities?
   Annals of Internal Medicine
 Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study
 Development and validation of a patient self-assessment score for diabetes risk
   Diabetes Care
 Comparison of a clinical model, the oral glucose tolerance test, and fasting glucose for prediction of type 2 diabetes risk in Japanese Americans
   Diabetic Medicine
 The impact of screening for Type 2 diabetes in siblings of patients with established diabetes
   Journal of Clinical Epidemiology
 Glucose screening and the risk of complications in Type 2 diabetes mellitus
Review
   Annals of Internal Medicine
 Tests of glycemia for the diagnosis of type 2 diabetes mellitus
Commentary
   ACP Journal Club
      Diabetes mellitus
 2010 - Review: Statin use increases risk for diabetes
 2009 - Pioglitazone was associated with lower risk for adverse cardiovascular events than rosiglitazone in older patients
 2009 - A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes
 2009 - A Mediterranean-style diet reduced need for glucose-lowering drugs more than a low-fat diet in type 2 diabetes
 2009 - Minimally invasive and conventional glucose monitoring did not differ for long-term glycemic control in insulin-treated diabetes
 2009 - Rosiglitazone was noninferior to metformin plus sulfonylurea for CV events but increased risk for HF and fractures in type 2 diabetes
 2009 - Review: Intensive glucose control reduced some CV events but did not change mortality in type 2 diabetes
 2009 - Bariatric surgery was cost-effective at 2 years for management of type 2 diabetes in obese patients
 2009 - Bariatric surgery was dominant over conventional therapy for lifetime management of type 2 diabetes in obese patients
 2008 - Review: Metformin reduces risk for CV mortality compared with other oral diabetes drugs or placebo in type 2 diabetes
 2008 - Intensive insulin therapy reduced long-term risk for incident hypertension in type 1 diabetes
 2008 - Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years
 2008 - Benefits of tight blood pressure control to prevent diabetes complications were not sustained
 2008 - Glycemic control was not affected by self-monitoring of blood glucose in type 2 diabetes
 2008 - Self-monitoring of blood glucose was not cost-effective in non-insulin-treated type 2 diabetes
 2008 - Intensive insulin therapy improved glycemic control more than oral hypoglycemic agents in newly diagnosed type 2 diabetes
 2008 - Intensive glucose control did not prevent important complications in type 2 diabetes
 2008 - Intensive glucose control increased mortality and did not prevent cardiovascular events in type 2 diabetes
 2008 - Review: Little evidence exists on the benefits and harms of screening for and treating gestational diabetes
 2008 - A targeted, multifactorial intervention reduced mortality in patients with type 2 diabetes and microalbuminuria
 2008 - Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes
 2008 - Review: Statins prevent stroke and reduce mortality
 2007 - Thiazolidinediones increased risk for heart failure, myocardial infarction, and death in older patients with type 2 diabetes
 2007 - Aerobic plus resistance training was more effective than either alone for reducing HbA1c levels in type 2 diabetes
 - Review: Long-acting insulin analogues do not improve glycemic control but do reduce nocturnal hypoglycemia in diabetes
 2007 - Review: beta-blockers for hypertension increase risk for new-onset diabetes compared with nondiuretic antihypertensive agents
 2007 - Review: Thiazolidinediones increase congestive heart failure but not cardiovascular deaths in prediabetes or type 2 diabetes
 2007 - Self-monitoring of blood glucose did not improve glycemic control in patients with type 2 diabetes not treated with insulin
 2007 - Review: Incretin therapy improves glycemic control more than placebo in patients with type 2 diabetes
 2007 - Review: Thiazolidinediones increase risk for heart failure in type 2 diabetes
 2007 - Impaired fasting glucose and impaired glucose tolerance, as well as known diabetes, increased risk for death within 5 years
 2007 - Review: Meglitinide analogues reduce glucose levels in type 2 diabetes, but morbidity and mortality effects are unknown
 2007 - Review: Rosiglitazone increases risk for MI but does not differ from other drugs for CV death in type 2 diabetes
 2007 - Rosiglitazone increased heart failure but did not differ from metformin plus sulfonylurea for other CV outcomes at interim analysis
 2007 - A portion-control plate was effective for weight loss in obese patients with type 2 diabetes mellitus
 2007 - Review: Long-acting insulin analogues reduce risk for hypoglycemia compared with NPH insulin in type 2 diabetes
 2007 - Vildagliptin was effective as add-on therapy in type 2 diabetes inadequately controlled with metformin monotherapy
 2007 - Intensive insulin therapy during cardiac surgery did not reduce mortality or morbidity but increased risk for stroke
 2007 - Review: Angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors have the lowest risk for diabetes
 2007 - Vildagliptin was noninferior to rosiglitazone for glycemic control in type 2 diabetes but caused less weight gain
 2006 - A lifestyle intervention continued to prevent type 2 diabetes in high-risk patients after the program was stopped
 2006 - Review: Inhaled insulin provides better glycemic control than oral hypoglycemic agents but not better than subcutaneous insulin
 2006 - Sitagliptin improved glycemic control and beta-cell function in type 2 diabetes
 2006 - Simvastatin was cost-effective across a broad range of risk and age groups
 2006 - Rosiglitazone reduced type 2 diabetes but increased heart failure in patients with impaired glycemic control
 2006 - Ramipril did not reduce incident diabetes in patients with impaired glycemic control
 2006 - Review: ACE inhibitors and angiotensin-receptor blockers reduce diabetes in hypertension and other CV risk factors
 2006 - Atorvastatin did not prevent cardiovascular events in type 2 diabetes
 2006 - Adjunctive inhaled insulin before meals improved glycemic control more than adjunctive metformin in type 2 diabetes mellitus
 2005 - Intensive insulin therapy reduced cardiovascular disease in type 1 diabetes
 2005 - Review: Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers prevent type 2 diabetes
 2005 - Candesartan prevented development of diabetes mellitus in heart failure
 2005 - Screening and active management reduced perinatal complications more than routine care in gestational diabetes
 2005 - Review: alpha-Glucosidase inhibitors improve glycemic control but have uncertain effects on patient-important outcomes in type 2 diabetes
 2005 - A lifestyle intervention or metformin prevented or delayed the onset of the metabolic syndrome in persons at risk
 2005 - Review: Mixed signals from trials concerning pharmacologic prevention of type 2 diabetes mellitus
 2004 - Review: Insulin monotherapy and insulin combined with oral hypoglycemic agents provide similar glycemic control
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
 2005 - Diuretic-based therapy reduced cardiovascular mortality in older patients with isolated systolic hypertension and diabetes
 2004 - A dietitian-led intervention reduced weight and waist circumference in obese patients with type 2 diabetes
 2004 - Review: Fluoxetine, orlistat, and sibutramine modestly reduce weight in type 2 diabetes
 2003 - Review: Metformin does not increase risk for lactic acidosis or increase lactate levels in type 2 diabetes
 2003 - Review: Interventions focusing on patient behaviors in provider-patient interactions improve diabetes outcomes
 2003 - Acarbose reduced the risk for cardiovascular disease and hypertension in impaired glucose tolerance
 - Review: Rosiglitazone or pioglitazone as add-on therapy is effective for glycemic control in type 2 diabetes
 2003 - Enalapril reduced the risk for new-onset diabetes in left ventricular dysfunction
 2003 - A counseling strategy was better than usual care for adopting and maintaining physical activity in type 2 diabetes
 2003 - Combining fasting plasma glucose and glycosylated hemoglobin improved the accuracy for detecting patients with diabetes
 2002 - Training in flexible intensive insulin management improved glycemic control and quality of life in type 1 diabetes
 2002 - Losartan reduced cardiovascular morbidity and mortality more than atenolol in patients with diabetes and essential hypertension
 2002 - Review: Metformin does not increase fatal or nonfatal lactic acidosis or blood lactate levels in type 2 diabetes mellitus
 2002 - A split regimen of regular insulin at dinner and NPH insulin at bedtime reduced nocturnal hypoglycemia in type 1 diabetes
 2002 - A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk
 2001 - Review: Stress hyperglycemia after ischemic stroke indicates a greater risk for death in patients without diabetes
 2001 - Several simple rules predicted complications in high-risk patients with diabetes
 2001 - Cardiovascular events were increased in high cardiovascular risk patients with albuminuria
 2001 - Changes in diet and physical activity prevented type 2 diabetes mellitus in persons with impaired glucose tolerance
 2001 - Review: Self-management training in type 2 diabetes mellitus is effective in the short term
 2000 - Glyburide was as safe and effective as insulin in gestational diabetes
 2000 - Review: Self-monitoring does not improve blood glucose control in type 2 diabetes mellitus
      Insulin-dependent diabetes
 2008 - Intensive insulin therapy reduced long-term risk for incident hypertension in type 1 diabetes
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
      Non-insulin-dependent and insulin-dependent diabetes
 2010 - Review: Statin use increases risk for diabetes
 2009 - Review: Current evidence shows no overall benefit of aspirin for primary prevention of cardiovascular disease in diabetes
 2009 - Gabapentin and nortriptyline combined was better than either drug alone for relief of neuropathic pain
 2009 - Darbepoetin decreased transfusions and fatigue, but increased adverse effects in patients with chronic kidney disease, diabetes, and anemia
 2009 - Pioglitazone was associated with lower risk for adverse cardiovascular events than rosiglitazone in older patients
 2009 - Continuous androgen-deprivation therapy increased risk for diabetes and fragility fractures in older men with prostate cancer
 2009 - Use of antipsychotic drugs was associated with increased risk for hyperglycemia in older patients with diabetes
 2009 - Adding prompt revascularization to medical therapy did not reduce mortality or CV events in patients with type 2 diabetes and CAD
 2009 - Rosiglitazone was noninferior to metformin plus sulfonylurea for CV events but increased risk for HF and fractures in type 2 diabetes
 2009 - Review: Intensive glucose control reduced some CV events but did not change mortality in type 2 diabetes
 2009 - Review: Diabetes is not a coronary disease equivalent
 2009 - Screening for CAD in asymptomatic patients with type 2 diabetes did not reduce risk for cardiac events
 2009 - Bariatric surgery was cost-effective at 2 years for management of type 2 diabetes in obese patients
 2009 - Bariatric surgery was dominant over conventional therapy for lifetime management of type 2 diabetes in obese patients
 2009 - Adding metformin to insulin did not improve a composite of microvascular and macrovascular disease in type 2 diabetes
 2009 - Intensive primary care treatment reduced cardiovascular risk factors at 1 year in screen-detected type 2 diabetes
 2008 - Review: Metformin reduces risk for CV mortality compared with other oral diabetes drugs or placebo in type 2 diabetes
 2009 - Intensive and standard glucose control did not differ for major CV events or death in poorly controlled type 2 diabetes
 2008 - Aspirin and/or antioxidants did not prevent CV events in diabetes and peripheral arterial disease
 2008 - Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years
 2008 - Benefits of tight blood pressure control to prevent diabetes complications were not sustained
 2008 - Intensive insulin therapy improved glycemic control more than oral hypoglycemic agents in newly diagnosed type 2 diabetes
 2008 - Intensive glucose control did not prevent important complications in type 2 diabetes
 2008 - Intensive glucose control increased mortality and did not prevent cardiovascular events in type 2 diabetes
 2008 - Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes
 2008 - Review: Statins prevent stroke and reduce mortality
 2007 - Thiazolidinediones increased risk for heart failure, myocardial infarction, and death in older patients with type 2 diabetes
 2007 - Review: beta-blockers for hypertension increase risk for new-onset diabetes compared with nondiuretic antihypertensive agents
 2007 - Review: Thiazolidinediones increase congestive heart failure but not cardiovascular deaths in prediabetes or type 2 diabetes
 2007 - Self-monitoring of blood glucose did not improve glycemic control in patients with type 2 diabetes not treated with insulin
 2007 - Review: Tricyclic antidepressants, anticonvulsants, opioids, and capsaicin cream are effective treatments for diabetic neuropathy
 2007 - Review: Evidence for major benefits and harms of antidiabetic agents for diabetes with heart failure is limited
 2007 - Review: Thiazolidinediones increase risk for heart failure in type 2 diabetes
 2007 - Review: Meglitinide analogues reduce glucose levels in type 2 diabetes, but morbidity and mortality effects are unknown
 2007 - Review: Long-acting insulin analogues reduce risk for hypoglycemia compared with NPH insulin in type 2 diabetes
 2007 - Vildagliptin was effective as add-on therapy in type 2 diabetes inadequately controlled with metformin monotherapy
 2007 - Review: Angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors have the lowest risk for diabetes
 2007 - Vildagliptin was noninferior to rosiglitazone for glycemic control in type 2 diabetes but caused less weight gain
 2007 - Collaborative care for depression in patients with diabetes increased depression-free days and had economic benefit
 2006 - A lifestyle intervention continued to prevent type 2 diabetes in high-risk patients after the program was stopped
 2006 - Review: Inhaled insulin provides better glycemic control than oral hypoglycemic agents but not better than subcutaneous insulin
 2006 - Ramipril did not reduce incident diabetes in patients with impaired glycemic control
 2006 - Review: ACE inhibitors and angiotensin-receptor blockers reduce diabetes in hypertension and other CV risk factors
 2006 - Atorvastatin did not prevent cardiovascular events in type 2 diabetes
 2006 - Adjunctive inhaled insulin before meals improved glycemic control more than adjunctive metformin in type 2 diabetes mellitus
 2006 - Review: ACE inhibitors delay onset of microalbuminuria in diabetes without nephropathy and reduce mortality in diabetic nephropathy
 2005 - Long-term fenofibrate therapy did not reduce major coronary events but may reduce total CVD events in type 2 diabetes mellitus
 2005 - Pioglitazone did not reduce a composite endpoint of macrovascular complications and increased risk for heart failure in type 2 diabetes with macrovascular disease
 2005 - Candesartan prevented development of diabetes mellitus in heart failure
 2005 - A lifestyle intervention or metformin prevented or delayed the onset of the metabolic syndrome in persons at risk
 2005 - Simvastatin was cost-effective for reducing major vascular events in vascular disease or diabetes mellitus
 2005 - Intensive insulin-glucose infusion regimens with long-term or standard glucose control did not differ for reducing mortality in type 2 diabetes mellitus and MI
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
 2005 - Diuretic-based therapy reduced cardiovascular mortality in older patients with isolated systolic hypertension and diabetes
 2003 - Review: Interventions focusing on patient behaviors in provider-patient interactions improve diabetes outcomes
 2003 - Acarbose reduced the risk for cardiovascular disease and hypertension in impaired glucose tolerance
 - Review: Rosiglitazone or pioglitazone as add-on therapy is effective for glycemic control in type 2 diabetes
 2003 - Enalapril reduced the risk for new-onset diabetes in left ventricular dysfunction
 2003 - Combining fasting plasma glucose and glycosylated hemoglobin improved the accuracy for detecting patients with diabetes
 2002 - Training in flexible intensive insulin management improved glycemic control and quality of life in type 1 diabetes
 2002 - Involving patients with type 2 diabetes, hypertension, and hyperlipidemia in disease management improved outcomes

Patient Information
Web
 ACP Foundation HEALTH TiPS: Diabetes
 American Diabetes Association: Pre-Diabetes
 American Diabetes Association: Risk Test
 Canadian Diabetes Association: Are You at Risk?
 National Diabetes Education Program: Am I at Risk?
 National Diabetes Education Program: Diabetes Control
 ACP Foundation HEALTH TiPS: Diabetes (Spanish)
 American Diabetes Association: Diabetes Risk Test (Spanish)
FAQs | Patient Information
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.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.


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