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Diabetes - Early Detection & Screening

Diabetes - Early Detection and Screening

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Introduction

Type 2 diabetes is often diagnosed late due to insidious onset and lack of symptoms early in the condition.

Approximately 850,000 people with diabetes in UK remain undiagnosed.

At diagnosis, approximately 30% already have microvascular complications.

Early diagnosis and management can delay or prevent long term complications.

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Early Detection
 

Clinical vigilance and awareness of modes of presentation is required for early recognition and diagnosis. (Diabetes Classification & Diagnosis)

 

Early diagnosis of new type 1 diabetes (see Urgent Referral Pathway - Management of Newly Diagnosed Diabetes) and prompt treatment with insulin, will reduce number of cases presenting severely ill with ketoacidosis and the associated mortality.

 

Raising public awareness of risk factors and symptoms of type 2 diabetes (History - Management of Newly Diagnosed Diabetes), will also lead to early presentation to healthcare professionals and diagnosis.

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Screening

General population screening for type 2 diabetes is not currently recommended.

 

Diabetes screening is part of the NHS Health Check process for adults between 40 and 74

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Targeted Screening

 

Targeted Screening - of individuals at risk is encouraged. Following    recommendation is based on Diabetes UK recommendations

Who to Test

 
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Age:

>40 years in White people

 

>25 years in Black, Asian and minority ethnic groups with

 
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First degree (parents/siblings) family history of diabetes and/or

 
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Overweight (BMI >25) with sedentary lifestyle and/or

 
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With ischaemic heart disease, cerebrovascular disease, peripheral vascular disease or hypertension and/or

 
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Women with PMH of gestational diabetes who tested normal post-delivery.

 
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Women with polycystic ovary syndrome who are obese

 
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Those known to have impaired glucose tolerance or impaired fasting glucose

 
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Increased waist circumference

   

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White or Black men >97 cm

   

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South Asians men >90cm

   

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Women >80

 
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History of pancreatic disease

 
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Long term steroid therapy

 
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Diabetes UK Self Assessment Risk Tool
     
 

How Often

 

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Every three years

 

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Women with gestational diabetes who tested normal post-delivery, should be tested annually

     
 

How to Test

     
 

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Fasting plasma blood glucose

     
   

Venous Plasma

Whole Blood

Interpretation

 

(capillary or venous)

 

≥ 7.0

≥ 6.1

Diabetes possible.  Perform diagnostic test (Diabetes Classification & Diagnosis Guideline)

6.1 - 6.9

5.6 6.0

IGT or IFG likely.  Perform OGTT (Diabetes Classification & Diagnosis Guideline)

< 6.1

< 5.6

Diabetes / IFG / IGT unlikely Rescreen as clinically indicated

   
 

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Plasma glucose 2 hrs after glucose load
   

 

   
 

Diabetes Mellitus

mmol/l

 

Fasting venous plasma glucose

≥ 7.0

or

 

Random or 2hr post glucose load

≥ 11.1

or both

 

Impaired Glucose Tolerance (IGT)

   
 

Fasting (if measured)

< 7.0

and

 

2hr

≥7.8 and ≤ 11.0

 

Impaired Fasting Glucose (IFG)

 
 

Fasting

≥ 6.1 and <7.0

and
 

2hr (if measured)

< 7.8

 
     
 

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HbA1c
   

At present the local position is that the glucose criteria should be used for diagnosis and that HbA1c should be restricted to the surveillance of those with demonstrated Impaired Glucose tolerance or Impaired Fasting Glucose

   

See expert position statement from UK Department of Health Advisory Committee on Diabetes 2012.

   
 

Response to Screening Results

 

 

 

 

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Normal : If no symptoms, no action required. If has symptoms suggestive of diabetes, seek advice from GP, screening test does not exclude diabetes.

 

 

 

 

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Abnormal: Inform person screened and arrange confirmatory test (Diabetes Classification & Diagnosis) via GP. No need to change dietary or drug therapy until diagnosis confirmed.

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Useful External Resources / Links

View

Self Assessment Diabetes Risk Test
Take the Diabetes UK Two Minute Test to determine whether you are at risk from diabetes.
PDF File

Use of HbA1c in the diagnosis of diabetes - Position tatement from UK Department of Health Advisory Committee on Diabetes 2012

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