Undiagnosed diabetes must be detected

EDITOR—Early identification of type 2 diabetes is vital for the future of diabetes care, in terms of reducing the impact both on the individual and on NHS resources. Wareham and Griffin question the need for a screening programme because the benefits of early detection and treatment of undiagnosed diabetes have not been proved.1 There is evidence, however, of the cost of treating the complications of diabetes, and the United Kingdom prospective diabetes study has indicated how to reduce the risk of those complications through intensive treatment. Surely in the new, patient focused NHS, this evidence makes a compelling argument for providing that intervention as early as possible.

The authors suggest that clinical management of people in whom diabetes has already been diagnosed should be optimised before a screening programme is considered. This is unacceptable. Shouldn't everyone in the United Kingdom have an equal chance of effective treatment from the NHS? Are we in a position to say that patients lucky enough to have their diabetes diagnosed because of where they live, or because they are better informed on health issues, deserve greater priority than others who have had diabetes unknowingly for several years? Treatment must be optimised, but it must also be provided to all who need it.

Decisions about screening should be based on the best available evidence. Further evidence is required to identify how, who, and how often people should be screened, but this will take time. In the meantime we cannot afford to ignore the people …