The process for screening for type 2 diabetes or those at high risk of the condition needs “careful re-evaluation”, according to analysis by UK researchers.
In what they believe is the first study on the effectiveness of testing methods, Leicester University researchers found that “multi-step” programmes lead to more patients responding to screening invitations.
“Performing a multi-step approach in a population screening increases the yield and decreases the number needed to screen”
Such programme also resulted in the number of those needing a final test for a definite diagnosis being reduced.
The researchers looked at studies involving the oral glucose tolerance test. They defined a one-step strategy as when participants were invited directly for OGTT and two, three/four step if participants were screened at one or more levels prior to invitation to OGTT.
They found that multi-step strategy increased the initial response rate to the invitation to screening for diabetes – regardless of invitation method – and reduced the number needed to have the final diagnostic test for a definite diagnosis.
The rate of people diagnosed with type 2 diabetes in a one-step programme was 6.6%, 13.1% when two steps were involved, but 27.9% in screening programmes involving three or four steps.
The number needed to be invited to an OGTT to detect one case of type 2 diabetes was 15 people for one-step programmes, 7.6 for two steps and 3.6 for strategies with three or four steps.
“The process of screening for type 2 diabetes or those at high risk of diabetes needs careful re-evaluation by local policy makers”
The research, published in the PLOS ONE journal, involved results from 47 existing studies and more than 400,000 patients from various countries.
Lead researcher Kamlesh Khunti, professor of primary care diabetes and vascular medicine, said: “We can conclude that performing a multi-step approach in a population screening increases the yield and decreases the number needed to screen by OGTT and in the two-step approach it even increases the initial response rate to the invitation.
“In terms of absolute numbers, the highest yield of diabetes, however, is obtained in the one-step studies where an OGTT is offered as a screening test to the population,” he said.
“The process of screening for type 2 diabetes or those at high risk of diabetes needs careful re-evaluation by local policy makers… in view of our findings,” he added.