Screening for NIDDM in Nonpregnant Adults: A review of principles, screening tests, and recommendations

N on-insulin-dependent diabetes mellitus (NIDDM) may be an appropriate disease for screening and early detection because it represents a sizable burden in the population, it can be identified in the preclinical (asymptomatic) phase, and the prognosis may be improved if it is detected and treated early.Although little information is currently available about the long-term impact of improved glycemic control in NIDDM, the weight of evidence may support taking a more aggressive approach.In addition, early detection of diabetes provides opportunities for tertiary preventions of blindness, renal failure, and amputations and for cardiovascular risk factor detection and treatment.Screening strategies must consider which populations to screen, the performance of screening tests, the interpretation of screening test results, counseling for participants, referral for diagnostic testing, referral and access to diabetes care, and the potential adverse effects of screening.Several organizations have made recommendations for screening, but the performance and cost-effectiveness of these strategies have not been evaluated.Here we review the principles of screening and discuss their application to screening for diabetes in nonpregnant adults.We also review issues of interpretation of screening test performance and assess some existing screening tests for NIDDM.Finally, we discuss and compare current recommendations for diabetes screening by various agencies, identify gaps in knowledge, and explore further research needs.