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Head To Head

Should we screen for type 2 diabetes? No

BMJ 2012; 345 doi: (Published 09 July 2012) Cite this as: BMJ 2012;345:e4516
  1. Elizabeth Goyder, professor1,
  2. Les Irwig, professor 2,
  3. Nick Payne, honorary senior lecturer1
  1. 1ScHARR, University of Sheffield, Sheffield S1 4DA, UK
  2. 2University of Sydney, Screening and Test Evaluation Program, Sydney School of Public Health, Sydney, New South Wales, Australia
  1. Correspondence to: E Goyder e.goyder{at}

Kamlesh Khunti and Melanie Davies (doi:10.1136/bmj.e4514) believe that screening for diabetes is feasible and cost effective, but Elizabeth Goyer and colleagues think that a population approach to modifying risk factors would be better

The main evidence for the benefits of identifying people at increased risk of type 2 diabetes, as well as those who already have diabetes, comes from trials of early intervention and modelling. These suggest that screening followed by lifestyle interventions promoting changes in diet and physical activity is both effective and cost effective in people at increased risk.1 2 However, none of the models directly examines the relative benefits of these individualised approaches compared with population approaches. We suggest that screening has several disadvantages and that a mean population approach to risk reduction may be more appropriate.

Disadvantages of screening

Cost effectiveness modelling clearly shows the advantages of making management decisions on the basis of overall cardiovascular risk rather than on the presence or absence of individual cardiovascular risk factors such as hypertension.3 Recent modelling suggests that it may be as effective to treat on the basis of age alone as on the basis of a more complex risk assessment including blood pressure and …

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