Blog entry by Meguid El Nahas
The UK ADDITION study of value of screening for DM has reported its findings in the Lancet.
This was a clinic level cluster randomised trial.
>16,000 high risk individuals were screened in general practice in the UK between ages of 40-69 for type2 diabetes mellitus.
3% were found to have DM upon screening.
Follow-up of 10 years of these cohorts showed no difference in mortality between screening and control group.
Moratlity hazard ratios for death from CVD, cancer and diabetes did not differ either.
The study has not reproted on microvascular complications and their incidence.
The low prevalence of 3% of T2DM in this high risk population may be a reason why the overall impact of screening on mortality has been limited. In populations with higher prevalence of obesity and T2DM, screening of those at risk may prove cost-effective.
Also, screening may allow to detect early complications of T2DM such as renal, cardiovascular, neuropathic and ocular involvements. These may take more than 10 years to fully express their morbidity and the associated mortality. Early detection may impact on progression of microvascular complications and overall outcomes in the longer term. Such secondary prevention of complications have not been reported by the ADDITION study yet.
Ultimately, the issue of obesity and T2DM is a societal one and one that involves primary prevention. Here lifestyle changes are key to outcomes but implementation of societal lifestyle changes take much more that mere encouragement to eat well and excercise....!!! Also barriers for implementation of lifestyle and metformin treatment for prevention of T2DM has previously been discussed on OLA.
Finally, lifestyle changes require huge economical commitments from governments with changes in internal migration, westernisation as well as urbanisation. It also requires urban planning with changes in the configuration of our communities and cities...In the current financial climate of recession and austerity, governments have other priorities on their minds....
Interesting to read in the Lancet this week about New York city efforts to reduce NCDs:
As New York City Mayor Michael Bloomberg has noted, “while government action is not sufficient alone, it is nevertheless absolutely essential. There are powers only governments can exercise, policies only governments can mandate and enforce, and results only governments can achieve. To halt the worldwide epidemic of non-communicable diseases, governments at all levels must make healthy solutions the default social option. That is, ultimately, government’s highest duty.
LIFESTYLE CHANGES....EASIER SAID THAN DONE...AND SUSTAINED....SPECIALLY AMONGST THE MOST DEPRIVED!!!!