I often have heard that people have found out they have diabetes after being admitted to a hospital because of diabetes-related issue (ketoacidosis, passing out because of hypoglycemia, etc.). I gather from this thread that the test used to detect diabetes (fasting blood glucose level test) is not routinely performed: it is performed when a person has a family history of diabetes or may be found to be susceptible to develop diabetes.
What useful would routine fasting blood sugar level tests be for non-diabetics coming in for a check-up? Would this help find diabetes in people faster and easier? Or would this not reap any benefit?
For healthy adults without hypertension or high cholesterol, an “I” recommendation:
— The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing diabetic screening. Evidence that diabet screening is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
For adults with hypertension or high cholesterol, a “B” recommendation:
— The USPSTF recommends that clinicians provide diabetic screening to eligible patients. The USPSTF found at least fair evidence that diabetic screening improves important health outcomes and concludes that benefits outweigh harms.
Oops! Here’s their full rationale for not yet recommending general screening for an otherwise healthy, asymptomatic public who don’t have hypertension or high cholesterol:
I see my internist yearly, since I have moderate hypertension. He always orders labs on me, including fasting glucose and cholesterol. IIRC, my insurance company has approved this for several years now. I don’t have diabetes in my family history, but I am overweight and have been sedentary for 6 months now due to degenerative joint disease. So my cholesterol is up :eek: but at least we can treat it with diet, meds and exercise (as soon as I get my hip replacement). My glucose is WNL, thank Og.
Oh, but there is a way. A simple fasting blood glucose is a fair screening test to pick up glucose intolerance or early diabetes. It’s just that to routinely screen-test everyone would be very expensive, and so far there’s no solid evidence that it would make a difference in outcomes. Hence the current stance that we may as well wait until symptoms show up to test for it, if early detection has not been shown to be of benefit. Note that the screening test is recommended for high risk groups like those with elevated blood pressure or cholesterol.
If evidence is found that routine screening does have more benefits than risks, then the Task Force will undoubtably recommend that routine screening be done. But it will be very, very costly. Screen over 100 million American adults? How often? Who pays?
That’s why we need solid evidence that screening makes a difference in outcomes before making a commitment to screen a whole bunch of people.
I see my doctor every January/February for my annual physical. I make an appointment months ahead so that I can get in first thing (8:30 - 9:00). Not waiting for hours on an empty stomach. My insurance thinks that annual checkups are so important that they pay for it completely. No co-pay. She does a complete blood and urine workup, again completely paid by insurance. It’s no big deal. However, she does now have several years of history on my blood sugar, cholesterol, trigylcerides, thyroid, etc. levels. It I ever have problems later down the road, she knows what is “normal” for me. If you are going to the doctor for an annual physical (and you should), then you might as well skip breakfast for a couple of hours and make the physical worth while.
Truthfully, I think a random (non-fasting) test would be a better idea. I’m a diabetic who tested “normal” for years when they did the fasting glucose (and my fasting levels are still mostly within “normal” limits). It wasn’t till the day I went in for a checkup an hour and a half after eating a lunch that included a can of Pepsi that I got the bad news. I’d had my suspicions for quite a while, which is why I insisted on all those fasting glucose tests in the first place.
I think everyone ought to have a glucose test at least once a year. Even if it’s just a quick finger-poke and run through the meter at the nurse’s station. The earlier you get the bad news, the faster you can do something about it.
No, it wouldn’t. Even if you pay full price as an individual consumer, a blood glucose meter is less than $100 and the test strips are about 75¢ each or thereabouts depending on manufacturer. I’m sure a doctor’s office could get that stuff for free. Granted, a home-use meter wouldn’t be as accurate as a lab test, but as a screening tool it would be more than enough.
Actually there’s a fair amount of controversy about the accuracy of home glucose monitors for screening purposes. And if we’re going to screen 100 million people, we have to make sure of the results.
Not saying they can’t be made useful for the purpose, but it’s not so cut and dried as all that.
