Screening Exercise (1)

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Florida International University *

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6003

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Medicine

Date

Apr 3, 2024

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pdf

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4

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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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