Who should be screened for the presence of type 2 diabetes?
Patients with blood pressure greater than 135/80 mmHg should be screened no more frequently than every 3 years for the presence of type 2 diabetes. In patients with both hypertension and type 2 diabetes, coronary heart disease prevention should be intensified, since strict control of blood glucose offers only a small benefit in comparison. (LOE = 5)
U.S. Preventive Services Task Force. Screening for Type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2008;148(11):846-854. [PMID:18519930]
This guideline from the United States Preventive Services Task Force (USPSTF) is based on a systematic review evaluating the current evidence of benefit for screening for type 2 diabetes (Ann Intern Med 2008;148:855-68). There is no direct evidence of benefit of screening for diabetes as compared with treating patients when the diagnosis is made. Even then, intensive control of blood glucose has not been shown to reduce macrovascular and other patient-oriented outcomes. However, there may be benefit to intensifying coronary heart disease strategies -- aspirin, blood pressure control, lipid lowering -- in patients identified with type 2 diabetes. The USPSTF recommends screening for type 2 diabetes in patients with treated or untreated blood pressure greater than 135/80 mmHg (grade B recommendation: moderate to high certainty of a moderate to high benefit). They do not recommend screening of asymptomatic individuals without this slight elevation in blood pressure.
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