Screening for NIDDM in nonpregnant adults. A review of principles, screening tests, and recommendations.

The economic burden of diabetes in the U.S. is now more than 90 billion dollars per year (113-115). In the diabetes community, there is a feeling that aggressive measures to detect diabetes in earlier stages may be warranted. Regardless of whether evidence is convincing that there are benefits from early detection of diabetes (3,116,117), screening activities have been sanctioned by many organizations and are now taking place. Operational research is needed to define more clearly the who, when, where, and how of screening and the effectiveness of screening programs (4,118). Diabetes screening programs should be comprehensive and should educate about diabetes and provide appropriate interpretation of both positive and negative screening results. It is essential that programs have diagnostic follow-up and refer those with newly diagnosed diabetes for treatment. In addition, individuals with previously diagnosed diabetes encountered during screening activities should be made aware of the importance of glycemic control and follow-up with their health care providers.