Screening Exercise (1)
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School
Florida International University *
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Course
6003
Subject
Medicine
Date
Apr 3, 2024
Type
Pages
4
Uploaded by gschim on coursehero.com
Part 2:
Using the article by Sui (2015) responds to the following criteria for appraising a
screening program.
1.
The condition that the article by Siu focuses on involves screening for abnormal
blood glucose, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT),
as it relates to diagnosing type 2 diabetes mellitus in asymptomatic adults. The
condition is an important health problem as Diabetes is a metabolic disorder that
can additionally contribute to the burden of cardiovascular disease on the health
system. This can lead to a massive strain on the health system in the following
years.
2.
The epidemiology and natural history of Diabetes are understood and there is a
detectable risk factor. The condition is understood to exhibit an abnormal glucose
metabolism, such as IFG and IGT, which can lead to type 2 diabetes. A substantial
portion of these individuals are at risk for cardiovascular disease which develops
slowly over time. This allows for a latent period in which early symptoms can be
identified and treated early.
3.
The screening test mentioned in the article is a Hemoglobin A1C test. Which has
merit as a reliable diagnostic test for diabetes. The American Diabetes Association
recommends an HBA1C level of 6.5% or higher as a criterion for diabetes. The
article also mentions a lack of sensitivity and specificity values. Karnchanasorn
references a sensitivity value 43.3%which represents true positive results and a
specificity value of 99.3% which represents the proportion of true negatives.
4.
The article discusses some guidelines/recommendations on handling positive tests.
These include offering or referring patients with abnormal blood glucose to
intensive behavioral counseling interventions to encourage a healthy diet and
physical activity. These are ways that clinicians have been advised to handle
positive tests.
5.
There are effective treatments or interventions for patients identified through
early detection, with evidence of early treatment leading to better outcomes than
late treatment. The article mentions that lifestyle interventions have been found to
be moderately effective in reducing the progression from IFG or IGT to type 2
diabetes. These interventions have proven to be more effective than certain
medications such as metformin.
6.
The article does not mention agreed-upon evidence-based
guidelines/recommendations about who should be treated and how. It does
suggest that lifestyle interventions are effective and these interventions typically
align with dietary and physical activity guidelines for optimal health. While every
individual will have their own treatment journey with Diabetes typically people use
insulin pumps or medications to manage their symptoms. Treatment interventions
are typically weight loss, exercise, or physical activity to mitigate the effects of
diabetes.
7.
I think the benefit of the screening program outweighs physical and psychological
harm. While there may be short-term anxiety associated with diagnosis which may
be considered psychological harm there is no significant effect to the impact of
screening individuals for diabetes. I do think that the screening can offer
individuals who may be at risk at least the knowledge that they may have diabetes.
This could encourage lifestyle changes and prevent the condition from developing
further.
8.
There is evidence from a randomized controlled trial that a screening program is
not very effective in reducing mortality/morbidity. According to a review by the
Annals of Internal Medicine from 2015, they assessed the effectiveness of diabetes
screening and used randomized controlled trials to evaluate the impact of early
detection on mortality and morbidity. The review’s findings were inconclusive as
there is insufficient evidence to establish a clear causal connection between
screening and reductions in mortality and morbidity relating to diabetes. This calls
for more research to understand the condition further and how to improve
screening processes.
Selph, S., Dana, T., Blazina, I., Bougatsos, C., Patel, H., & Chou, R. (2015).
Screening for type 2 diabetes mellitus: a systematic review for the U.S.
Preventive Services Task Force.
Annals of internal medicine
,
162
(11), 765–776.
https://doi.org/10.7326/M14-2221
9.
Is screening for Type-2 diabetes cost-effective? Cite one peer-reviewed article
(preferably from a study conducted in the U.S.) that supports that screening for
pre-diabetes or Type-2 diabetes is or is not cost-effective. Make sure to include the
reference you used.
A systematic review from 2016 regarding the Cost-effectiveness of type 2 diabetes
screening, published by the Medical Journal of the Islamic Republic of Iran,
concluded that screening for diabetes is cost-effective. The health outcome
measures also vary depending on the initiation age for screening, the cutoff point
for diagnosis, and standards of national healthcare costs. It may vary differently in
Germany vs the United States, but for the purposes of this question, the American
study supports that screening for diabetes is cost-effective at higher ages like 55
and 65 over 35 years of age but still cost-effective nonetheless.
Najafi, B., Farzadfar, F., Ghaderi, H., & Hadian, M. (2016). Cost-effectiveness of
type 2 diabetes screening: A systematic review.
Medical Journal of the Islamic
Republic of Iran
,
30
, 326.
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