title: Effect of screening for Type 2 diabetes on population-level self-rated health outcomes and measures of cardiovascular risk: 13-year follow-up of the Ely cohort.
abstract: OBJECTIVE
  There is continuing uncertainty regarding the overall net benefits of population-based screening for Type 2 diabetes. We compared clinical measures, prescribed medication, cardiovascular morbidity and self-rated health in individuals without diabetes in a screened vs. an unscreened population.
  
  
  METHODS
  A parallel-group, cohort study of people aged 40-65 years, free of known diabetes, identified from the population register of a general practice in Ely, Cambridgeshire (n = 4936). In 1990-1992, one third (n = 1705), selected randomly, received an invitation for screening for diabetes and cardiovascular risk factors at 5-yearly intervals (screened population). From the remainder of the sampling frame, 1705 randomly selected individuals were invited to diabetes screening 10 years later (unscreened population). Patients without known diabetes from both populations were invited for a health assessment.
  
  
  RESULTS
  Of 3390 eligible individuals without diabetes, 1442 (43%) attended for health assessment, with no significant difference in attendance between groups. Thirteen years after the commencement of screening, self-rated functional health status and health utility were identical between the screened and unscreened populations. Clinical measures, self-reported medication and cardiovascular morbidity were similar between the two groups.
  
  
  CONCLUSIONS
  Screening for diabetes is not associated with long-term harms at the population level. However, screening has limited long-term impact on those testing negative; benefits may largely be restricted to those whose diabetes is detected early through screening.
authors.affiliation: General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.forename: R K
authors.initials: RK
authors.lastname: Simmons
authors.forename: S H
authors.initials: SH
authors.lastname: Hennings
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: S J
authors.initials: SJ
authors.lastname: Griffin
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006304:Health Status; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology