Routine screening for silent ischaemia in diabetes did not cut events, and PEth and AUDIT caught different drinkers

The edition in brief

A meta-analysis of five randomised trials (3,315 asymptomatic adults with diabetes and no known coronary disease) found routine screening for silent ischaemia did not significantly reduce major cardiovascular events (pooled HR/RR 0.76, 0.48 to 1.19), and harms such as false positives were poorly reported. In Swedish primary care records, the AUDIT questionnaire classed 26.5% of tested patients as hazardous drinkers, phosphatidylethanol (PEth) above 210 ng/mL 14.6% to 18.3%, and self-reported weekly drinks 8.5%; each method identified patients the others missed, and the authors advise reading PEth alongside self-report. A synthesis of 32 qualitative studies covering 677 primary care practitioners found confidence managing urinary tract infection gave way to uncertainty with children, men, older adults and recurrent infection, compounded by system pressure and patient expectations. A UK general practice feasibility study found a timed corridor walk was the most practical way to measure walking speed in a diabetes clinic, with recruitment of 30 of 33 patients. None of today's studies is a new treatment trial; the screening review is the one most likely to change what is ordered.