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The Article in Brief
Yield of Opportunistic Targeted Screening for Type 2 Diabetes in Primary Care: The Diabscreen Study
Erwin P. Klein Woolthuis , and colleagues
Background The American Diabetes Association recommends that high-risk adults be tested for diabetes. This study assessed the results of opportunistic targeted screening for type 2 diabetes in the primary care setting.
What This Study Found The yield of an opportunistic targeted screening program was fair: in 1year, undiagnosed type 2 diabetes was identified in 101 high-risk patients (2.7%). The yield of screening in low-risk patients was only 0.4%. Of the American Diabetes Association risk factors, obesity was the strongest predictor of undiagnosed type 2 diabetes.
Implications
- Opportunistic screening for type 2 diabetes in primary care could target middle-aged and older adults with obesity.
- These findings confirm a low yield in screening low-risk individuals for diabetes.
Annals Journal Club Selection:
Sep/Oct 2009
The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1How it Works
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.
Article for Discussion
- Klein Woolthuis EP, de Grauw WJC, van Gerwen WHEM. Yield of opportunistic targeted screening for type 2 diabetes in primary care: the Diabscreen study. Ann Fam Med. 2009;7(5):422-430.
Discussion Tips
Although screening for diabetes is not recommended for the general population, a great deal of case finding for diabetes occurs through tests ordered for various reasons. The article by Klein Woolthuis and colleagues in this issue can be used to stimulate consideration of whether and how to screen for type 2 diabetes.Discussion Questions
- What question is addressed by the article? How does the question fit with what already is known on this topic?
- How strong are the study design and data source for answering the question?
- To what degree can the findings be accounted for by:
- How participants were selected?
- How outcomes were measured?
- Confounding (false attribution of causality because two variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- What are the main findings?
- How comparable is the study population to your practice, and how does this effect the transportability of the findings?
- How might the high-risk groups be different if the study were done in US family practices?
- How relevant are the findings to consideration of screening for the general population?
- How do the recommendations of the US Preventive Services Task Force2 and the American Diabetes Association3 inform your consideration of these findings? How and why do these recommendations differ?
- How (if at all) does this study change your practice?
- What important researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/cgi/content/full/4/3/196.
- US Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults. June, 2008. http://www.ahrq.gov/CLINIC/uspstf/uspsdiab.htm. Accessed Jul 25, 2009.
- American Diabetes Association (ADA). Standards of medical care in diabetes. II. Testing for pre-diabetes and diabetes in asymptomatic patients. Diabetes Care. 2008;31(Suppl 1):S13-S14. http://care.diabetesjournals.org/content/31/Supplement_1/S12.full. Accessed Jul 25, 2009.