Using a highly detailed mathematical model, the study concluded that early screening could greatly reduce diabetes-related complications at reasonable cost and also substantially reduce mortality.
'This study confirmed for us what we have long believed to be true but have never been able to show in clinical trials,' said John Buse, MD, PhD, former President, Medicine and Science of the American Diabetes Association and an author of the paper.
Because there are few symptoms in the early stages of development, diabetes can go undiagnosed for up to 10 years, while rising blood glucose levels begin to cause damage to the body. This can lead to costly and potentially devastating complications such as heart disease and stroke, kidney failure, blindness, and problems with the nerves, especially in the lower extremities, leading to risk of amputations. However, if blood glucose levels are properly controlled, people with diabetes can successfully prevent or delay complications of the disease.
That's why the American Diabetes Association has long recommended that adults be screened for diabetes starting by at least age 45 and that the test be repeated every three years. Younger adults with diabetes risk factors, such as obesity or family history, should begin screenings earlier. However, there have been no randomized, controlled trials to support this recommendation because such trials would be prohibitively expensive, requiring thousands of people without diabetes to be followed for decades.
This study, employing a complex and detailed mathematical model known as Archimedes, simulated 325,000 people matching the U.S. population in age, sex, health behaviors such as smoking, blood pressure levels, symptoms, medications and numerous other factors. The simulated population underwent nine different screening strategies in sequence, ranging from no screening to beginning screening at age 30 and repeating every six months. The simulated patients were followed for 50 years or until they died.
All the screening strategies reduced rates of heart attacks and diabetes-related complications (such as blindness, amputation and kidney failure) and most reduced death rates. Compared to no screening, most of the strategies were highly cost effective, that is, the cost was $10,000 or less per quality-adjusted life-year (a year of perfect health) added as a result of the intervention. Generally, interventions that cost less than $50,000 per QALY are considered cost-effective and worth recommending. The longer the wait to begin screening, the greater the cost. Waiting until age 45, for example, cost $15,000 per QALY gained, and waiting until age 60 cost $25,000 per QALY.
'Clearly there is value to diabetes screening starting between the age of 30 and 45, as recommended by the American Diabetes Association, in terms of the quality of a person’s life due to earlier diagnosis and the ability to prevent complications,' said Buse. 'This model now suggests for us that there is a financial value to diabetes screening as well.'
The Archimedes model has been validated for accuracy by predicting the results of more than 50 real-life clinical trials.