Population-based type 2 diabetes screening linked to reduced insulin use
medwireNews: People diagnosed with type 2 diabetes during population-based screening are less likely to need insulin after 10 years and may have slightly better glycemic control than those diagnosed during usual care, researchers report.
“Although our findings might seem obvious, because individuals diagnosed during [usual care] are likely to have a longer undiagnosed period, they are nevertheless clinically relevant,” say Rimke Vos (Leiden University Medical Center, the Netherlands) and co-investigators.
Vos and team compared insulin use among three cohorts of people with type 2 diabetes: a screen-detected cohort (ADDITION-NL) of people with diabetes for 10 years (n=391) and two cohorts (GIANTT and ZODIAC) of people who were diagnosed with diabetes during usual care and had a diabetes duration of 7 (n=4473) or 10 (n=2660) years.
The researchers note that they chose 7 years as a comparator because “[a] treatment legacy effect of population-based screening for type 2 diabetes of about 3 years” has previously been estimated.
As reported in BMJ Open Diabetes Research & Care, the rates of insulin prescription were 10.5%, 14.7%, and 19.0% in the 10-year screen detection, 7-year usual care, and 10-year usual care groups, respectively.
After adjustment for potential confounders, the likelihood of being prescribed insulin was a significant 1.5- and 1.8-fold higher in the 7- and 10-year usual care cohorts than in the 10-year screen detected cohort.
The researchers also found that glycated hemoglobin levels were slightly lower at 10 years after screen detection of type 2 diabetes than at 7 and 10 years after detection during usual care, with mean values of 6.7% (50 mmol/mol) versus 6.9% (52 mmol/mol) and 7.0% (53 mmol/mol), respectively.
Vos et al point out that a previous trial, ADDITION-DK, suggested that “population-based screening has no additional benefits above opportunistic screening on risk reduction on [cardiovascular disease] mortality.”
However, they believe their results “indicate that population-based screening might result in a delayed need for insulin, which may influence the discussion on population-based versus opportunistic screening for type 2 diabetes.”
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