Ditch square root formula, demand out-of-pocket GPs
A population screening programme for type 2 diabetes could cut long-term death rates by more than a fifth, suggests data from a major study that is being scrutinised by Government advisers.
Ministers' chief screening adviser described the new finding as 'very important' and the GP study leader predicted the launch of a national general practice-based screening programme 'sooner rather than later'.
Dr Simon Griffin's team found that screening all 40- to 65-year-olds every five years with an oral glucose tolerance test (OGTT) cut overall
mortality in that age group by 22 per cent during the
14-year follow-up period.
'I can't think of many health promotion interventions in the world that produce a 22 per cent fall in population mortality,' said Dr Griffin, senior lecturer in general practice at the University of Cambridge and a GP in the city.
His study compared overall death rates among 1,706 people aged 40-65, who were randomly selected in 1990 to receive invitations for five-yearly OGTT screening, against mor- tality among 3,231 controls.
GPs were given test results, including values for cholesterol, triglyceride, blood pressure and glycosylated haemoglobin, but were not given any specific advice on treatment.
Some 108 patients had positive OGTTs during the three rounds of screening and 581 patients died during the 14.3 years of follow-up.
After adjusting for age, gender and deprivation, mortality in the group invited for screening regardless of whe-ther they took up the invitation was 22 per cent lower than in controls.
Among those who attended for screening, mortality was 42 per cent lower than in controls, according to data presented to the Society for Academic Primary Care conference last week.
Dr Griffin cautioned against making policy on the basis of his retrospective study and urged the Government to await data from prospective randomised trials before investing billions in national screening.
But he added political pressure could force the National Screening Committee to commit to a limited screening programme for overall CVD risk in high-risk groups 'sooner rather than later'. He said: 'I think the committee is convinced of the benefits.'
Dr Muir Gray, director of the committee, said he hoped a decision would be made by the end of the year. 'This study was very well designed and very important,' he said.
But he added the committee's pilot sites would provide detail on the practicalities and cost-effectiveness of diabetes screening.
Dr Griffin advised GPs awaiting the decision to add a fasting glucose test to routine monitoring of patients with pre-existing CHD or treated hypertension.
By Jo Haynes