Eleanor Barry|Samantha Roberts|Jason Oke|Shanti Vijayaraghavan|Rebecca Normansell|Trisha Greenhalgh
Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions
University of Oxford|University of Oxford|University of Oxford|Newham University Hospital|Barts Health NHS Trust|St George's, University of London|University of Oxford
assess diagnostic accuracy screening tests prediabetes efficacy interventions lifestyle metformin preventing onset type 2 diabetes people prediabetes systematic review metaanalysis medline premedline embase study protocols seminal papers citationtracked google scholar identify definitive trials additional publications data study design methods findings extracted onto excel spreadsheets 20 sample checked second researcher data extracted screening tests included diagnostic accuracy population prevalence two metaanalyses performed one summarising accuracy screening tests oral glucose tolerance test standard identification prediabetes assessing relative risk progression type 2 diabetes either lifestyle intervention treatment metformin empirical studies evaluating accuracy tests identification prediabetes interventions randomised trials interventional studies control group people identified screening language restrictions 2874 titles scanned 148 papers covering 138 studies reviewed full final analysis included 49 studies screening tests five prevalence studies 50 intervention trials hba1c mean sensitivity 049 95 confidence interval 040 058 specificity 079 073 084 identification prediabetes though different studies used different cutoff values fasting plasma glucose mean sensitivity 025 019 032 specificity 094 092 096 different measures glycaemic abnormality identified different subpopulations example 47 people abnormal hba1c glycaemic abnormality lifestyle interventions associated 36 28 43 reduction relative risk type 2 diabetes six months six years attenuating 20 8 31 followup period trails hba1c neither sensitive specific detecting prediabetes fasting glucose specific sensitive interventions people classified screening prediabetes efficacy preventing delaying onset type 2 diabetes trial populations screening inaccurate many people receives incorrect diagnosis referred interventions others falsely reassured offered intervention findings suggest screen treat policies alone unlikely substantial impact worsening epidemic type 2 diabetes prospero crd42016042920