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RESEARCH: Helen C Eborall, Simon J Griffin, A Toby Prevost, Ann-Louise Kinmonth, David P French, and Stephen Sutton Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial BMJ 2007; 335: 486 [Abstract] [Full text]

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Does screening for type 2 diabetes have any negative psychosocial impact?

John Brodersen, Professor, PhD Stephen P McKenna, Associate Director of Research Lynda Doward, and Senior researcher, PhD Hanne Thorsen   (8 September 2007)

Do Editors read articles?

Shahid Amin   (10 September 2007)

Does screening for type 2 diabetes have any negative psychosocial impact? 8 September 2007
John Brodersen, MD, GP, PhD, post doc Department and Research Unit of General Practice, University of Copenhagen, 1014K Denmark, Professor, PhD Stephen P McKenna, Associate Director of Research Lynda Doward, and Senior researcher, PhD Hanne Thorsen Send response to journal: Re: Does screening for type 2 diabetes have any negative psychosocial impact?	We read with interest the study by Eborall and colleagues about the psychological impact of screening for type 2 diabetes.(1) In the introduction the authors state that: "Another limitation of previous studies is the use of general anxiety measures. Studies on the impact of cancer screening suggest no detectable effect on measures of general anxiety but a substantial effect on disease specific measures". However, the patient reported outcome measures used in the Eborall study are such generic measures. To measure the outcomes of screening accurately and comprehensively questionnaires have to capture: • the nature of the specific psychosocial consequences, • the extent of these consequences, and • changes in the psychosocial consequences over time.(2) The authors used two generic instruments; the Hospital Anxiety and Depression Scale (HADS) and a six item version of the State Trait Anxiety Inventory (STAI-6). These measures have been shown to be inadequate in capturing the psychosocial consequences of false-positive breast cancer screening due to problems with their language, content relevance and content coverage.(3) Qualitative studies of the psychosocial consequences of screening show that areas such as; sleeping problems, sense of dejection and negative impact on behaviour and sexuality can also be important psychosocial consequences.(4) The authors do not report field- testing the measures to establish their content validity in the setting of type 2 diabetes screening. Another problem with using generic questionnaires is that such instruments’ psychometric properties vary across populations.(5) Again, the authors do not report any psychometric testing of the unidimensionality, reproducibility, invariance or validity of the HADS and STAI-6 in this context. Therefore, the addition of responses to the HADS and STAI-6 items to produce total scores and the calculation of mean values may well not be justifiable. In summary, we find that the conclusion of the study by Eborall and colleagues is based on inadequate measures, insufficient psychometric methods and unjustifiable calculations. The question “does screening for type 2 diabetes have any negative psychosocial impact?” must therefore remain tentative. Reference List (1) Eborall HC, Griffin SJ, Prevost AT, Kinmonth AL, French DP, Sutton S. Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ 2007; 335(7618):486. (2) Brodersen J, McKenna SP, Doward LC, Thorsen H. Measuring the psychosocial consequences of screening. Health Qual Life Outcomes 2007; 5(1):3. (3) Brodersen J, Thorsen H, Cockburn J. The adequacy of measurement of short and long-term consequences of false-positive screening mammography. Journal of Medical Screening 2004; 11(1):39-44. (4) Brodersen J, Thorsen H, Kreiner S. Validation of a condition- specific measure for women having an abnormal screening mammography. Value in Health 2007; 10(4):294-304. (5) Hobart JC, Williams LS, Moran K, Thompson AJ. Quality of life measurement after stroke: uses and abuses of the SF-36. Stroke 2002; 33(5):1348-1356. Competing interests: None declared
Do Editors read articles? 10 September 2007
Shahid Amin, GP Rectory House Surgery HP13 6QG Send response to journal: Re: Do Editors read articles?	Hi Page 3 shows a picture of urine stix testing with caption "Screening for type 2 diabetes, pp 486,490". The articles do not mention urine testing for screening, but do mention random blood glucose measurements. Picture of a glucometer with a drop of blood is what was needed.... Urine screening for new diabetics is practice from the last century. Pictures are very powerful tools for conveying information or "misinformation" .... using the right tool is a skill. Competing interests: None declared