Long-Term Effect of Population Screening for Diabetes on Cardiovascular Morbidity, Self-Rated Health, and Health Behavior

• Published in: Annals of family medicine 2015-03, Vol.13 (2), p.149-157
• Main Authors: Echouffo-Tcheugui, Justin B., PhD, Simmons, Rebecca K., PhD, Prevost, A. Toby, PhD, Williams, Kate M., PhD, Kinmonth, Ann-Louise, MD, Wareham, Nicholas J., PhD, Griffin, Simon J., DM
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcohol Drinking - epidemiology; Cardiovascular Diseases - epidemiology; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - therapy; England - epidemiology; Female; Health Behavior; Health Status; Humans; Internal Medicine; Longitudinal Studies; Male; Mass Screening; Middle Aged; Motor Activity; Myocardial Infarction - epidemiology; Original Research; Self Report; Smoking - epidemiology; Stroke - epidemiology; Surveys and Questionnaires
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1737

ABSTRACT PURPOSE There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors. METHODS We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the no-screening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis. RESULTS Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of self-rated health status (β –0.33, 95% CI, –1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, –1.28 to 2.87); total physical activity (β 0.50, 95% CI, –4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, –1.07 to 1.35). CONCLUSIONS Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.