1. Rebecca K Simmons, Justin B Echouff o-Tcheugui, Stephen J Sharp, Lincoln A Sargeant, Kate M Williams, A Toby Prevost, Ann Louise Kinmonth, Nicholas J Wareham, Simon J Griffin Lancet 2012; 380: 1741–48 R3 조영학, R1 김동연 / Prof. 이상열

2. Introduction Type 2 diabetes : major public health challenge Evidence for screening high proportion of undiagnosed cases of diabetes (30– 50%) large number of individuals with complications at clinical diagnosis long latent phase (9–12 years)

3. benefits of population-based screening and early treatment for type 2 diabetes  uncertainty Compared to Breast cancer, prostate cancer, cervical cancer screening for diabetes  both diabetes-related and overall mortality ↓ ? We assessed the effect of a population-based stepwise screening programme on mortality

4. ADDITION study Anglo-Danish-Dutch Study in General Practice of Intensive Treatment and Complication Prevention in Type 2 Diabetic Patients Identified by Screening 4 centers in Denmark, UK (Cambridge, Leicester), Netherland began in 2000 and is still in motion 1. To evaluate the effect of screening for prevalent undiagnosed type-2 diabetes 2. To evaluate the effect of intensive treatment in patients with screen detected type-2 diabetes http://www.addition.au.dk

5. ADDITION-Cambridge trial

6. Methods

7. Results

8. Discussion In large UK sample, invitation to one round of screening for type 2 diabetes in high-risk individuals was not associated with a reduction in all-cause or diabetes-related mortality over 10 years

9. Programme of screening for diabetes every 3–5 years reduce diabetes-related mortality in Taiwan by 26–40% prevent up to five deaths per 1000 people in USA non-significant 21% lower all-cause mortality in Ely, UK  non-randomised study, differed from this study - International journal of epidemiology 1999 Apr;28(2):233-40 - Lancet. 2010 Apr 17;375(9723):1346-74 - Diabetologia. 2011 Feb;54(2):312-97

10. Several possible explanations for the lack of difference in mortality Opportunistic screening in UK primary care mortality in high-risk individuals in the control group being 50% lower than Netherlands Proportion of diabetes might have been too small to affect population mortality one screening round higher risk of mortality : not attended > attended Effects on mortality cardiovascular disease > diabetes cancers : now the most common cause of death in UK

11. Strength first trial to evaluate the effect of screening programme for type 2 diabetes on population mortality randomised design reducing the possibility of selection, lead, length time bias large number of high-risk individuals Follow-up 10 years

12. Conclusion In this large UK sample, screening for type 2 diabetes was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years The benefits of screening might be smaller than expected and restricted to individuals with detectable disease Benefits to the population could be increased by detection and management of related cardiovascular risk factors alongside assessment of diabetes risk repeated rounds of screening identification of non-attenders and strategies to maximise uptake of screening

13. - Lancet 2011; 378: 156–67