Age and frequency for most effective Type 2 diabetes screening suggested
MedWire News: Results obtained using a mathematical model indicate that screening for Type 2 diabetes in the US population is cost effective when started at age 30–45 years and repeated every 3–5 years.
Richard Kahn (American Diabetes Association, Alexandria, Virginia, USA) and colleagues created a simulated population of 325,000 nondiabetic individuals aged 30 years with demographic characteristics derived from the National Health and Nutrition Examination Surveys 1999–2004. The simulated population was followed up for 50 years or until they died.
The Archimedes model, a detailed large-scale simulation model of physiology, disease, and healthcare systems, was used to compare eight simulated strategies for Type 2 diabetes screening with a no screening policy. The eight strategies differed by age at initiation and frequency of screening.
The efficacy of each strategy was judged based on incidence of Type 2 diabetes, cardiovascular events such as myocardial infarction (MI), stroke, and other microvascular complications, as well as quality of life, economic costs, and cost per quality-adjusted life-year (QALY).
Writing in The Lancet, Kahn and team report that, compared with no screening, all the simulated screening strategies reduced the incidence of MI and diabetes-related microvascular complications by 3–9 events per 1000 people.
The number of QALYs was also increased by the eight strategies by 93–194 undiscounted QALYs over the 50-year follow-up.
In addition, six strategies prevented a significant 2–5 deaths per 1000 people, but there was little to no effect on stroke incidence, with only 0–1 event prevented per 1000 people.
For five of the screening strategies, costs per QALY were around US$10,500 (€7794) or less. A strategy starting at age 45 years and repeated yearly cost US$15,509 (€11,513), one starting at age 60 years and repeated every 3 years cost US$25,738 (€19,106), and a maximal screening strategy starting at age 30 years with 6-monthly screening cost US$40,778 (€30,271).
The team concludes that screening for Type 2 diabetes would be cost effective when started between the ages of 30 and 45 years and repeated at 3 to 5 year intervals.
Guy Rutten (University Medical Center Utrecht, The Netherlands), the author of an accompanying commentary, said: “Today’s paper provides further evidence that screening for diabetes should be combined with screening for hypertension and lipid tests.”
He added: “Further input into the model of information on screen-detected people with Type 2 diabetes, and separate analyses of different populations or healthcare systems, might strengthen the role of the Archimedes model to provide further useful information for future guidelines about screening for diabetes.”
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By Helen Albert