Researchers at the VA Medical Center in Durham published their findings in the January issue of Journal of General Internal Medicine. Among 1,253 VA outpatients without recognized diabetes, 4.5 percent were found to have the disease. Of these, 61 percent required a change in treatment for conditions including undesirable blood sugar levels and hypertension, based upon their newfound status.
According to lead author David Edelman ,M.D., the study finds that opportunistic screening is likely more cost-effective, with the added benefit of being easily dovetailed into a typical office visit.
The opportunistic approach also takes advantage of a doctor-patient relationship that doesn’t exist in community testing, such as health fairs. This relationship promotes a greater likelihood that patients will follow-up on their medical care upon discovering a significant risk of diabetes – a disease that affects approximately 16 million Americans, according to the American Diabetes Association. Furthermore, it’s estimated that nearly five million people don’t know they have the disease.
"Theoretically, the screening methods studied could be adopted by VA medical centers all over the country almost immediately. What we have here is a very practical way of discovering previously undiagnosed cases of diabetes." Edelman said.
Edelman also noted that another aspect of opportunistic screening is the use of a non-fasting test, where patients are not required to refrain from eating prior to screening.
"The downside to fasting tests, while more direct with a better sensitivity and specificity than any non-fasting tests, is that patients don’t always fast. There are significant benefits in not having to worry about that. The non-fasting test also gives us important information on how severe the diabetes is, so you know right from the beginning what the urgency of intervention is," Edelman said.
Opportunistic diabetes screening may have far-reaching treatment benefits beyond discovery and treatment of diabetes alone.
"Most of the patients who tested positive had either blood sugars, blood pressures or cholesterol levels that needed specialized treatment when their diabetes was factored in," Edelman said. "Even the ones who have only moderately high blood sugars often have high blood pressures that merit a different treatment strategy within the context of diabetes."
Although this study does not prove that opportunistic screening for diabetes is the more effective or more cost-effective alternative, it demonstrates that there is little downside to this type of screening within medical centers, compared to community-based screening.
This study was funded by the VA Cooperative Studies Program. Co-authors with Dr. Edelman are Lloyd J. Edwards, Ph.D., of Duke University; and the Durham VA Medical Center’s Maren K. Olsen, Ph.D., Tara K. Dudley, Amy C. Harris, Dana K. Blackwell and Eugene Z. Oddone, M.D.
Journal
Journal of General Internal Medicine