A major study was just published in Lancet that addressed the issue of whether or not diabetes screening in primary care improves major health outcomes.
This was a 10-year randomized controlled trial!! In other words, this study is the granddaddy of them all in terms of the rigor of its methods. Other diabetes screening projections published in the past were based on models and speculation.
The investigators conducted the study in 33 general practices in England. 20,284 patients at high risk of having diabetes (as calculated by a validated clinical score) were put into one of three arms: screening followed by intensive multifactorial treatment for those patients diagnosed with diabetes, screening followed by routine diabetes care for those diagnosed with diabetes, and a usual care control group with no routine screening.
Twenty thousand patients followed for 10 years is an enormous undertaking that is rarely accomplished in medical research.
The result after 10 years was that only 3% of the high-risk patients actually had or developed diabetes. There was no difference in overall deaths, cardiovascular deaths, cancer, or diabetes-related mortality between the screening and control groups.
In 2008, the U.S. Preventive Services Task Force determined that diabetes screening should not be performed in family medicine populations except for patients with a diagnosis of high blood pressure. I don’t think there is a randomized controlled trial that shows any great outcomes in this population either, but at least let’s give the USPSTF credit for its appropriate caution to not recommend screening in a more general population.
The Institute of Medicine and Price Waterhouse Coopers recently estimated that 30-36% of healthcare spending in this country is wasted. While family physicians are the foundational answer to a more effective and cost-effective healthcare system, they have their own imperfections to improve upon.
For all those family physicians out there who believe that annual labs are a necessary part of a wellness visit (except for occasional cholesterol checks in middle-aged patients), recognize that you are just as much a fearmonger as an ologist promoting over-testing and over-treating. You’re wasting precious healthcare resources. Stop it.