new diabetes guidelines (not targeted to cystic fibrosis)

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By Rauscher

NEW YORK (Reuters Health) Aug 18 - Current recommendations for diabetes

mellitus screening in asymptomatic, undiagnosed adults are effective and, if

followed, would detect virtually all new cases of diabetes, according to a

report in

the August 18 PNAS Early Edition.

Given that about one third of diabetes cases go undiagnosed, two researchers

from the University of Texas Medical Branch in Galveston wondered whether

screening guidelines, proposed by the Expert Committee on the Diagnosis and

Classification of Diabetes Mellitus and adopted by several medical societies,

are

adequate to catch new cases of diabetes. The guidelines recommend screening

at

3-year intervals beginning at 45, and earlier and/or more frequent screening

in

people with risk factors.

Drs. Florence J. Dallo and C. Weller examined the performance of the

diabetes screening guidelines using the National Health and Nutritional

Examination Survey (NHANES III), in which 6,241 individuals are classified as

nondiabetic and 274 as having undiagnosed diabetes based on their blood

glucose level.

They found that screening all adults with at least one risk factor for

diabetes, as recommended in the guidelines, would catch nearly 100% of new

cases of

diabetes but would require that 83% of the adult population be screened.

Screening when two risk factors are present is " more efficient, " they say,

identifying 98% of cases of diabetes by screening only 59% of the adult

population. " This additional 24% reduction in testing could have a large

impact on the

cost of testing in the United States, " they write.

The fact that one third of diabetes cases continue to go unnoticed suggests

that the guidelines are not being followed, according to Drs. Dallo and

Weller.

Another " notable " finding, according to the team, is that minorities often

develop diabetes before age 45, the currently recommended age to begin

screening. This 45-year cutoff may need to be reconsidered, Dr. Weller told

Reuters

Health.

" Very simple rules like testing everyone 45 years of age and older may not be

the best rule to follow because that would miss almost half of the minority

patients, " she said. " A better simple rule is to remember to test whites that

are 40 and older and minorities that are 30 and older. "

Proc Natl Acad Sci USA 2003.