Diabetes Screening

A new Lancet study had researchers looking at the number of deaths over 10 years among more than 20,000 people, aged 40 to 69, in England. All of them were at high risk for diabetes. The patients were divided into three groups. One group underwent a round of diabetes screening that was followed up by routine care for those diagnosed with diabetes; another group had a round of screening followed by intensive management for those diagnosed with diabetes; and a third group did not undergo diabetes screening. Over an average follow-up of nearly 10 years, the overall death rates in the groups that had diabetes screening were no lower than in the group that had no screening. There also was no significant difference between the groups in the number of deaths specifically from diabetes, cardiovascular illness, cancer or other causes.

I know these results seems counterintuitive and it is just one study but 20,000 people is a lot of research subjects to look at.  What if it is right?   Would our government and insurance companies heed the new recommendations?  There are bogus quality indicators that pay doctors who screen such measures.   If screening for type 2 diabetes does not appear to reduce the risk of death in the general population, it would make this performance measure obsolete.    One more reason that P4P, quality initiatives, and benchmarks are not good for healthcare!   Doctors need to be allowed to treat patients as people and not numbers.  You cannot industrialize medicine.



Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Diabetes Screening

  1. Melinda
    October 11, 2012 at 6:23 pm

    To Pat Nagle–You “gather” wrongly–the study states that the groups which had screening, regardless of whether they were then followed by routine care or intensive management, had no change in death rate over those never screened. What would make sense and be expected as the outcome of the study, and which you presumed to have “gathered” from the report, is the exact opposite of what was found.

    Another example of how quickly people see what they expect to see and presume that it is just there and go on believing whatever they already believe.

  2. Pat Nagle
    October 10, 2012 at 1:29 pm

    I gather that the group with intensive followup did better. Perhaps that Tx motivated them to follow their doctors’ advice more thoroughly than those with just screening or routine followup?

  3. lagaya
    October 8, 2012 at 3:30 pm

    Here is a great video about overdiagnosis by G Gilbert Welch. He deals mostly in cancer overdiagnosis, but I imagine the same problems arise in many other diagnoses as well.http://drmcdougall.com/video/expert_testimonies_h_gilbert_welch_over-diagnosed.htm

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