Screening for type 2 diabetes
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* Wally Shishkov

This is in response to the Controversy articles concerning type 2 diabetes.[1, 2] I agree with Kenneth Marshall that screening for type 2 diabetes is largely unnecessary. Insulin resistance, which is at the early end of the spectrum of type 2 diabetes, is marked by features that are easily observed, including a tendency to be shaped like an apple despite exercise or unsupervised calorie restriction or both, bloating, indigestion, shakiness before meals, sleepiness after meals, intermittent swelling of the hands and feet with ring tightening, and frequent momentary light-headedness when standing up from a reclining position.

The North American epidemic of "diabesity" (type 2 diabetes plus obesity, otherwise known as the insulin resistance syndrome) is affecting a growing proportion of the population. This disorder, which is fully reversible in its early stages, is not being adequately acknowledged or dealt with in a unified manner by the health care system. I do not agree with the assumption that very few people are able to achieve and maintain weight loss. If there was a consensus among physicians to get serious about helping patients to lose weight the profession would be well on the way to dealing with roots of problems rather than tips of icebergs. (Figure)

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/161/7/797.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/161/7/797.2/F1)

Figure. 

Unfortunately, physicians have been provided with guidelines for disease management of a condition that is totally reversible. Clinical practice guidelines need to be completely rethought. Experts in this field inadvertently perpetuate the disease-management industry by quarreling (entertaining controversies and rebuttals) over mostly self-serving conceptual differences instead of aiming for some consensus that can be readily accepted and applied to improve public health. This is highly unbecoming of medical science.

## References

1.  1. Marshall KG. The folly of population screening for type 2 diabetes. *CMAJ* 1999;160(11)1592-3.
    
    

2.  2. Gerstein HC, Meltzer S. Preventive medicine in people at high risk for chronic disease: the value of identifying and treating diabetes. CMAJ 1999;160(11):1593-5.
    
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