Researchers call for more diabetes testing

But experts do not agree on who should be screened, and many patients fail to get the test when it's recommended.

By Victoria Stagg Elliott, AMNews staff. Sept. 22/29, 2003.

Screening all adults older than 45 and those with certain risk factors such as obesity or a family history of the disease is an effective way to find all diabetes cases and deal with the more than one-third of diabetics who are believed to be undiagnosed, according to a paper published in the September Proceedings of the National Academy of Sciences.

"We could be detecting these patients and we're not. And we could be bringing them into treatment," said Susan C. Weller, PhD, lead author and professor of preventive medicine and community health at the University of Texas Medical Branch in Galveston.

Many specialists agree that the more screening the better, because they see the downstream effects of late diagnosis -- the heart attacks, the kidney disease, the blindness, the loss of limbs.

"It's not uncommon to diagnose diabetes at the time of renal failure or the time of the first MI," said Francine Kaufman, MD, past president of the American Diabetes Assn. "The earlier we get them, we could theoretically get rid of all of that."

Still, some physicians aren't quite so convinced that the benefits of wider screening outweigh the drawbacks. Many suspect there are benefits from earlier diagnosis, but science has yet to offer definitive proof.

"The criteria are so far-reaching that it's a small step between the current criteria and just saying 'do a fasting glucose on every adult,'" said Ken Bertka, MD, a family physician in Toledo, Ohio. "Yes, diabetes is very important but there's all sorts of other things out there, and when you're trying to make good public health policy, it's important to make sure that you're really spending the money and the effort wisely."