Should we screen for type 2 diabetes? Evaluation against National Screening Committee criteria

The condition

· The condition should be an important health problem

· The epidemiology and natural history of the condition, including development from latent to declared disease, should be adequately understood and there should be a detectable risk factor, disease marker, latent period, or early symptomatic stage

· All the cost effective primary prevention interventions should have been implemented as far as practicable

The test

· There should be a simple, safe, precise, and validated screening test

· The distribution of test values in the target population should be known and a suitable cut off level defined and agreed

· The test should be acceptable to the population

· There should be an agreed policy on the further diagnostic investigation of individuals with a positive test result and on the choices available to those individuals

The treatment

· There should be an effective treatment or intervention for patients identified through early detection, with evidence of early treatment leading to better outcomes than late treatment

· There should be agreed evidence based policies covering which individuals should be offered treatment and the appropriate treatment to be offered

· Clinical management of the condition and patient outcomes should be optimised by all health care providers prior to participation in a screeningprogramme

The screening programme

· There should be evidence from high quality randomised controlled trials that the screening programme is effective in reducing mortality or morbidity

· There should be evidence that the complete screening programme (test, diagnostic procedures, treatment/intervention) is clinically, socially, and ethically acceptable to health professionals and the public

· The benefit from the screening programme should outweigh the physical and psychological harm caused by the test, diagnostic procedures, and treatment

· The opportunity cost of the screening programme (including testing, diagnosis, and treatment) should be economically balanced in relation to expenditure on medical care as a whole

· There should be a plan for managing and monitoring the screening programme and an agreed set of quality assurance standards

· Adequate staffing and facilities for testing, diagnosis, treatment, and programme management should be available prior to the commencement of the screening programme

· All other options for managing the condition should have been considered (eg, improving treatment, providing other services) 

Source: National Screening Committee. First report of the National Screening Committee. London: Health Departments of the United Kingdom, 1998. www.nsc.nhs.uk/pdfs/nsc_firstreport.pdf (accessed 14 January 2001).