Screening for Prediabetes and Type 2 Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance: Type 2 diabetes is common and is a leading cause of morbidity and disability. Objective: To review the evidence on screening for prediabetes and diabetes to inform the US Preventive Services Task Force (USPSTF). Data Sources: PubMed/MEDLINE, Cochrane Library, and trial registries through September 2019; references; and experts; literature surveillance through May 21, 2021. Study Selection: English-language controlled studies evaluating screening or interventions for prediabetes or diabetes that was screen detected or recently diagnosed. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when at least 3 similar studies were available. Main Outcomes and Measures: Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms. Results: The review included 89 publications (N = 68882). Two randomized clinical trials (RCTs) (25120 participants) found no significant difference between screening and control groups for all-cause or cause-specific mortality at 10 years. For harms (eg, anxiety or worry), the trials reported no significant differences between screening and control groups. For recently diagnosed (not screen-detected) diabetes, 5 RCTs (5138 participants) were included. In the UK Prospective Diabetes Study, health outcomes were improved with intensive glucose control with sulfonylureas or insulin. For example, for all-cause mortality the relative risk (RR) was 0.87 (95% CI, 0.79 to 0.96) over 20 years (10-year posttrial assessment). For overweight persons, intensive glucose control with metformin improved health outcomes at the 10-year follow-up (eg, all-cause mortality: RR, 0.64 [95% CI, 0.45 to 0.91]), and benefits were maintained longer term. Lifestyle interventions (most involving >360 minutes) for obese or overweight persons with prediabetes were associated with reductions in the incidence of diabetes (23 RCTs; pooled RR, 0.78 [95% CI, 0.69 to 0.88]). Lifestyle interventions were also associated with improved intermediate outcomes, such as reduced weight, body mass index, systolic blood pressure, and diastolic blood pressure (pooled weighted mean difference, -1.7 mm Hg [95% CI, -2.6 to -0.8] and -1.2 mm Hg [95% CI, -2.0 to -0.4], respectively). Metformin was associated with a significant reduction in diabetes incidence (pooled RR, 0.73 [95% CI, 0.64 to 0.83]) and reduction in weight and body mass index. Conclusions and Relevance: Trials of screening for diabetes found no significant mortality benefit but had insufficient data to assess other health outcomes; evidence on harms of screening was limited. For persons with recently diagnosed (not screen-detected) diabetes, interventions improved health outcomes; for obese or overweight persons with prediabetes, interventions were associated with reduced incidence of diabetes and improvement in other intermediate outcomes

Optical modelling and analysis of the Q and U bolometric interferometer for cosmology

International audienceRemnant radiation from the early universe, known as the Cosmic Microwave Background (CMB), has been redshifted and cooled, and today has a blackbody spectrum peaking at millimetre wavelengths. The QUBIC (Q&U Bolometric Interferometer for Cosmology) instrument is designed to map the very faint polaristion structure in the CMB. QUBIC is based on the novel concept of bolometric interferometry in conjunction with synthetic imaging. It will have a large array of input feedhorns, which creates a large number of interferometric baselines. The beam from each feedhorn is passed through an optical combiner, with an off-axis compensated Gregorian design, to allow the generation of the synthetic image. The optical-combiner will operate in two frequency bands (150 and 220 GHz with 25% and 18.2 % bandwidth respectively) while cryogenically cooled TES bolometers provide the sensitivity required at the image plane. The QUBIC Technical Demonstrator (TD), a proof of technology instrument that contains 64 input feed-horns, is currently being built and will be installed in the Alto Chorrillos region of Argentina. The plan is then for the full QUBIC instrument (400 feed-horns) to be deployed in Argentina and obtain cosmologically significant results. In this paper we will examine the output of the manufactered feed-horns in comparison to the nominal design. We will show the results of optical modelling that has been performed in anticipation of alignment and calibration of the TD in Paris, in particular testing the validity of real laboratory environments. We show the output of large calibrator sources (50 ° full width haf max Gaussian beams) and the importance of accurate mirror definitions when modelling large beams. Finally we describe the tolerance on errors of the position and orientation of mirrors in the optical combiner