Screening in Diabetes Mellitus: Report of the Atlanta Workshop

Abstract

A Diabetes Screening Workshop was held in Atlanta, Georgia, May 15--17, 1978, which was sponsored by the Center for Disease Control, the American Diabetes Association, and the National Institute of Arthritis, Metabolism, and Digestive Diseases. The workshop formulated the following recommendations for the use of screening procedures in diabetes mellitus from a community control viewpoint: (1) screening for asymptomatic glucose intolerance should be done among pregnant women as part of a well-coordinated program to decrease perinatal morbidity and mortality; (2) screening programs to detect asymptomatic glucose intolerance per se are not recommended as health services in nonpregnant populations; (3) screening for diabetes or its complications for research purposes should be done only as part of well-designed studies focusing on identification of predictive factors, implementation and effectiveness of preventive and therapeutic measures, descriptive epidemiology in selected populations, dynamic and economic factors of the medical care system related to case detection and management, and the nature and effects of screening processes; (4) information and education programs for health care providers, parents, and the general public should be implemented to bring about increased awareness of the clinical signs and symptoms of diabetes; and (5) all persons known to have diabetes should be evaluated regularly for the detection and management of the common chronic complications of the disease.

A Multivariate Logistic Regression Equation to Screen for Diabetes

“…In 1978, the American Diabetes Association (ADA), the Centers for Disease Control and Prevention, and the National Institutes of Health recommended against screening for diabetes in nonpregnant adults (1). In 1989 and again in 1996, the U.S. Preventive Services Task Force recommended against screening for diabetes in nonpregnant adults (1,2), and in 2001, the ADA recommended against community screening for diabetes (3). Several recent studies have shown that age, sex, BMI, and current metabolic status affect blood glucose levels and have raised concerns about the performance of diabetes screening tests (4 -8).…”

Screening for diabetes in dental settings

“…The cost of regular evaluations, the side effects of inappropriately using oral hypoglycaemic agents and issues related to employability and insurability added to the negative view of the usefulness of diabetes screening programmes, and led to the medicine and federal agencies to reevaluate the worth of these programmes. As a consequence, in 1979 Herron noted that glucose intolerance should not be screened for in non-pregnant populations (Herron, 1979).…”

Populist instead of professional

“…The clinical features are not specific, and the diagnosis is often made only when there is a full range of the symptoms and signs that are associated with myxoedema." 2 The accuracy of this statement is borne out by the long delay in making a clinical diagnosis of hypothyroidism that was reported in the Maine study.…”

“…In 1978 a consensus conference on screening for diabetes was convened by the Centers for Disease Control in Atlanta. 2 The conclusion was that community screening was not justified, the principal reason being that there was no evidence that treatment which lowered blood glucose diminished the risk of diabetic complications. This view was reinforced by the negative results of the first major clinical trial of hypoglycaemic treatment in type II diabetes mellitus carried out by the University Group Diabetes Programme.…”