[Screening for diabetes in France: data from the 2000-2001 cohort of the national medical insurance system].
BACKGROUND
Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test.


METHODS
We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (2000-2001). We used the administrative EPAS cohort from the employee National Health Insurance System which covers 70% of the total population in France. The data are based on reimbursements of glucose testing and hospitalization among people who did not received reimbursements of treatment for diabetes but used medical services during the 2 Years.


RESULTS
The opportunistic screening rate within 2 Years was 48.6% overall and increased with age. Among those 45 Years old or older, it was 71.2%. The screening rate was higher among women than men.


CONCLUSIONS
Opportunistic screening for diabetes is commonly practised in France, despite the lack of official guidelines. Several hypotheses may explain the discrepancy between common opportunist screening and high prevalence of undiagnosed diabetes: 1). undiagnosed diabetes is mostly present in people who do not use medical services; 2). opportunistic screening is not performed among the most at-risk population; 3). testing is not performed on fasting samples or results are neglected; 4). results of testing are overlooked by doctors/patients; 5). epidemiological studies based on self-report of diagnosis and only one testing overestimate undiagnosed diabetes.
Hirtzlin
I
I
Agence Nationale d'Accréditation et d'Evaluation en Santé, 2, avenue du Stade-de-France, 93218 Saint-Denis-La-Plaine Cedex. hirtzlin@univ-paris1.fr
Fagot-Campagna
A
A
Girard-Le Gallo
I
I
Vallier
N
N
Poutignat
N
N
Weill
A
A
Le Laidier
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005260:Female; D005602:France; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening; D008875:Middle Aged