title: Long-term effect of population screening for diabetes on cardiovascular morbidity, self-rated health, and health behavior.
abstract: OBJECTIVE
  There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors.
  
  
  METHODS
  We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the no-screening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis.
  
  
  RESULTS
  Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of self-rated health status (β -0.33, 95% CI, -1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, -1.28 to 2.87); total physical activity (β 0.50, 95% CI, -4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, -1.07 to 1.35).
  
  
  CONCLUSIONS
  Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Echouffo-Tcheugui
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Simmons
authors.affiliation: Department of Primary Care and Public Health Sciences, School of Medicine, King's College London, London, United Kingdom.
authors.forename: A Toby
authors.initials: AT
authors.lastname: Prevost
authors.affiliation: The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom.
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Kinmonth
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom The Primary Care Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom sjg49@medschl.cam.ac.uk.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Griffin
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009043:Motor Activity; D009203:Myocardial Infarction / Q000453:epidemiology*; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: ADDITION-Cambridge; cardiovascular morbidity; diabetes; health behavior; screening; self-rated health