On the 2nd of September 2019, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI-HTA) has released a report on guideline recommendations comprising screening for diabetes mellitus.
In order to identify relevant guidelines, systematic searches were conducted in four guideline databases and PubMed. In addition, a focused (Internet) hand-search was carried out. The authors included current, evidence-based guidelines on diabetes mellitus in German and English language. All recognizable recommendations referring to screening for diabetes mellitus or the corresponding screening procedures were extracted from the included guidelines. A structured synthesis of information was used to compare the contents of the recommendations from specific guidelines,.
In total, 14 relevant publications on 11 different guidelines were identified through the searches in the various sources. The included guidelines were published between 2012 and 2019 by societies in the USA and Canada (n=4), Europe (n=3), Australia (n=1), Qatar (n=2) and an international organization (n=1).
Nine of the 11 guidelines contained recommendations regarding screening for type 2 diabetes mellitus in adults. Recommendations on screening for type 1 diabetes mellitus in adults were found in 3 guidelines and on screening for diabetes mellitus in children and adolescents in 4 guidelines.
Results:
- Screening for diabetes mellitus type 1 for adults or for children/adolescents was generally not recommended. Similarly, a population-wide screening program for diabetes mellitus type 2 was not recommended
- For adults, a regular assessment of individual diabetes risk using validated risk assessment tools such as CANRISK or FINDRISC was recommended. Screening for type 2 diabetes mellitus using blood glucose monitoring was subsequently recommended for adults at high risk of diabetes. The guidelines consistently recommended a screening interval of 3 years
- Screening for type 2 diabetes mellitus was recommended for children and adolescents aged 8 to 10 years or older who are overweight or obese and have at least 1 additional risk factor for type 2 diabetes mellitus. In this case, the guidelines recommended a screening interval of 2 years. Again, only blood sugar measurements were recommended as a screening test. Urine glucose tests were not mentioned in the context of screening in any of the included guidelines.
Conclusions:
- The results of the report demonstrate that international evidence-based guidelines recommend screening for type 2 diabetes mellitus for those groups of people (adults and children/adolescents), who are at high risk for diabetes mellitus
- A recommendation for population-wide screening for diabetes mellitus is not given
- Overall, there are no significant inconsistencies between the guidelines regarding the recommendations on screening for diabetes mellitus. However, differences between the individual guidelines exist in the definition of high risk for diabetes mellitus.
The full report in German (with English summary) can be found here.
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