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How can we identify candidates at highest risk – to screen or not to screen?

Wie können wir Personen mit dem höchsten Diabetesrisiko identifizieren – screenen oder nicht screenen?

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Abstract

Type 2 diabetes (T2D) causes a large economic and health-care burden globally. This article summarizes the benefits and unsolved questions of screening for T2D. Many T2D risk assessment tools have been developed. Furthermore, current evidence has shown that T2D can be prevented by lifestyle interventions, justifying T2D screening. However, information is scarce on the long-term impact of T2D screening regarding health outcomes such as cardiovascular disease. Moreover, it is not certain whether health-care facilities and health-care staff are capable of implementing screening activities and subsequent interventions among high-risk individuals; lifestyle management tasks in particular are often not among the best skills that health-care personnel possess. Also, there is a lack of evidence for the periodicity of population-wide screening activities. As national health-care systems increasingly implement T2D screening, we may receive in the near future answers to some of our remaining research questions to fully assess the benefits and disadvantages of screening.

Zusammenfassung

Typ-2-Diabetes (T2D) ist eine große Belastung für die Wirtschaft und die Gesundheitssysteme weltweit. Dieser Artikel fasst die Vorteile und die ungelösten Fragen zum Screenen nach T2D zusammen. Bisher sind viele T2D-Risikobewertungsinstrumente entwickelt worden. Darüber hinaus haben aktuelle Forschungsergebnisse gezeigt, dass T2D durch Änderungen im Lebensstil vermieden werden kann, was das T2D-Screening im Prinzip rechtfertigt. Allerdings gibt es kaum Informationen über die langfristigen Auswirkungen des T2D-Screenings in Bezug auf gesundheitliche Auswirkungen, z. B. auf kardiovaskuläre Erkrankungen. Außerdem ist unklar, ob Gesundheitseinrichtungen und -personal in der Lage sind, die Screeningaktivitäten und die Folgemaßnahmen bei Personen mit hohem T2D-Risiko umzusetzen. Insbesondere Eingriffe in den Lebensstil zählen nicht zu den vorrangigen Aufgaben des Personals im Gesundheitswesen. Außerdem gibt es bislang nur ungenügende Dokumentationen hinsichtlich der Regelmäßigkeit der bevölkerungsweiten T2D-Screeningaktivitäten. Da nationale Gesundheitssysteme vermehrt auf T2D-Screenings setzen, werden wir wohl in naher Zukunft Antworten auf einige verbleibende Forschungsfragen erhalten, um die Vor- und Nachteile des Screenings vollständig beurteilen zu können.

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Authors and Affiliations

  1. Department of Public Health, Clinicum hallinto, University of Helsinki, Haartmaninkatu 8, 00014, Helsingin yliopisto, Finland

    N. C. Barengo & J. O. Tuomilehto

  2. Herbert Wertheim College of Medicine, Florida International University, 00014, Miami, USA

    N. C. Barengo

  3. Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271, Helsinki, Finland

    J. O. Tuomilehto

  4. Diabetes Research Group, King Abdulaziz University, 21589, Jeddah, Saudi Arabia

    J. O. Tuomilehto

  5. Dasman Diabetes Institute, 15462, Dasman, Kuwait

    J. O. Tuomilehto

  6. Centre for Vascular Prevention, Danube-University Krems, 3500, Krems, Austria

    J. O. Tuomilehto

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  1. N. C. Barengo
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Correspondence to N. C. Barengo.

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N. C. Barengo and J. O. Tuomilehto state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Barengo, N.C., Tuomilehto, J.O. How can we identify candidates at highest risk – to screen or not to screen?. Herz 41, 175–183 (2016). https://doi.org/10.1007/s00059-016-4417-5

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