This week we look beyond the Choosing Wisely Canada lists to look at another aspect of reducing unnecessary test and treatments.
A recent review in the British Medical Journal (see Quick Links) calls into question screening for diabetes and prediabetes in prevention of type 2 diabetes. Findings suggest that “screen and treat” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes.
Because of the low accuracy of screening tests and the limited reach of intervention programmes, policymakers might want to consider supplementing screen and treat policies with population based approaches aimed at entire communities. WHO, for example, proposes “multisectoral action that simultaneously addresses different sectors that contribute to the production, distribution and marketing of food, while concurrently shaping an environment that facilitates and promotes adequate levels of physical activity."
CardioBrief (again, see Quick Links) has an interesting analysis of the study noted above:
"Therapeutic trials to prevent progression to diabetes showed that some — but by no means most — cases of diabetes could be prevented. Lifestyle intervention trials resulted in a 37% relative risk reduction in developing diabetes, cutting the risk from 239 out of 1,000 in the control group to 151 out of 1,000 in the treatment group during the trial period. But the reduction in risk dropped sharply during follow-up studies. Using the drug metformin resulted in a 26% reduction in relative risk, from 295 out of 1,000 in the control group to 218 out of 1,000 in the treatment group."
The bottom line suggests that screening for diabetes is futile, metformin works no better than lifestyle changes, but as we all know it is very difficult to influence our patients to eat better and exercise more. Perhaps we need to turn our attention to influencing policy makers to implement broad policies to influence health.
...Sugar tax anyone?