A major study was just published in Lancet that addressed the issue of whether or not diabetes screening in primary care improves major health outcomes.
This was a 10-year randomized controlled trial!! In other words, this study is the granddaddy of them all in terms of the rigor of its methods. Other diabetes screening projections published in the past were based on models and speculation.
The investigators conducted the study in 33 general practices in England. 20,284 patients at high risk of having diabetes (as calculated by a validated clinical score) were put into one of three arms: screening followed by intensive multifactorial treatment for those patients diagnosed with diabetes, screening followed by routine diabetes care for those diagnosed with diabetes, and a usual care control group with no routine screening.
Twenty thousand patients followed for 10 years is an enormous undertaking that is rarely accomplished in medical research.
The result after 10 years was that only 3% of the high-risk patients actually had or developed diabetes. There was no difference in overall deaths, cardiovascular deaths, cancer, or diabetes-related mortality between the screening and control groups.
In 2008, the U.S. Preventive Services Task Force determined that diabetes screening should not be performed in family medicine populations except for patients with a diagnosis of high blood pressure. I don’t think there is a randomized controlled trial that shows any great outcomes in this population either, but at least let’s give the USPSTF credit for its appropriate caution to not recommend screening in a more general population.
The Institute of Medicine and Price Waterhouse Coopers recently estimated that 30-36% of healthcare spending in this country is wasted. While family physicians are the foundational answer to a more effective and cost-effective healthcare system, they have their own imperfections to improve upon.
For all those family physicians out there who believe that annual labs are a necessary part of a wellness visit (except for occasional cholesterol checks in middle-aged patients), recognize that you are just as much a fearmonger as an ologist promoting over-testing and over-treating. You’re wasting precious healthcare resources. Stop it.
Thanks for bringing this to our attention
Nothing like a massive dataset to drive home a point about waste and fear. Great post.
“You’re wasting precious healthcare resources. Stop it.”
Sorry, but as a family physician I’m getting REALLY tired of being lectured to about how it is my responsibility to save money for “the system.” Just by being a family doc, keeping my practice open, not joining a mega-group with an inflated fee schedule, and not charging a facility fee, I’m saving the system hundreds of thousands of dollars every year.
My little brain is just too full of more important stuff to worry about saving a buck here and there (the Medicare allowable for a fasting blood sugar is south of $3 in our neck of the woods). And it’s real clear to me that I have absolutely NO moral obligation to save money for the large for-profit insurers so they can pass it on to their CEOs and shareholders.
End of rant.
Have a good weekend.
Robert,
All rants from the heart are appreciated.
The major motivation for almost all my posts is to get everyone thinking about how we can reduce the exorbitant costs of U.S. healthcare. Thus, my concluding statement about scarce resources.
Resources aside, why would you ask your patients to have a needle stuck into their vein and blood sucked out of their body if the intervention does not improve their health?
This comes at a very opportune time, and makes me think I am not as stupid as it appears on tests.
Yesterday we did a group “SAM” sponsored by the KS AFP, on Preventive Care. The “right” answers are to screen, based on ADA recommendations. The ABFM exams jump around between USPSTF (best), CDC, and specialty organization recommendations (sometimes they just ask for an answer without telling you WHOSE recommendations they are using!)
Now I need to be able to tell my residents, as well as myself, “The right answer is ‘Don’t screen’. The right answer on the test is ‘screen’.” Thank you, ABFM
“30-36% of healthcare spending in this country is wasted. ”
Which country?
The U.S.