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‘Screen and treat’ unlikely to have major impact in preventing type 2 diabetes

Policies to ‘screen and treat’ people to prevent type 2 diabetes are unlikely to have a substantial impact on the growing diabetes epidemic, say researchers from the University of Oxford. 
Blood test

Policies to screen and treat people to prevent type 2 diabetes are unlikely to have a substantial impact on the growing diabetes epidemic, say researchers from the University of Oxford.

Screen and treat is one of two approaches to diabetes prevention. It involves identifying people at high risk of the disease and offering individual intervention. The other is a population-wide approach, which targets everyone via public health policies.

To assess the diagnostic accuracy of screening tests for pre-diabetes, and the effectiveness of interventions in preventing onset of type 2 diabetes in people with pre-diabetes, the researchers analysed the results of 49 screening tests and 50 intervention trials.

Screening tests included fasting plasma glucose and raised glycated haemoglobin (HbA1c). Interventions were lifestyle changes or treatment

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Policies to ‘screen and treat’ people to prevent type 2 diabetes are unlikely to have a substantial impact on the growing diabetes epidemic, say researchers from the University of Oxford.


‘Screen and treat’ involves identifying people at a high risk of diabetes and offering
individual intervention. Picture: Science Photo Library 

‘Screen and treat’ is one of two approaches to diabetes prevention. It involves identifying people at high risk of the disease and offering individual intervention. The other is a population-wide approach, which targets everyone via public health policies. 

To assess the diagnostic accuracy of screening tests for pre-diabetes, and the effectiveness of interventions in preventing onset of type 2 diabetes in people with pre-diabetes, the researchers analysed the results of 49 screening tests and 50 intervention trials. 

Screening tests included fasting plasma glucose and raised glycated haemoglobin (HbA1c). Interventions were lifestyle changes or treatment with the drug metformin. 

Benefitting some

The researchers found that the diagnostic accuracy of tests used to detect pre-diabetes in screening programmes was low. As fasting glucose is specific but not sensitive, and HbA1c is neither sensitive nor specific, large numbers of people could be unnecessarily treated or falsely reassured depending on the test used, the researchers said. 

Lifestyle interventions lasting three to six years showed a 37% reduction in relative risk of type 2 diabetes, and use of metformin showed a relative risk reduction of 26% while study participants were taking it. 

The researchers concluded that ‘screen and treat’ policies will benefit some but not all people at high risk of developing type 2 diabetes, and should be complemented by population-wide approaches for effective diabetes prevention. 


Barry E et al (2017) Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. BMJ. doi: http://dx.doi.org/10.1136/bmj.i6538 

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