Call to extend screening for diabetes

GPs are being encouraged to screen people at high risk of type-2 diabetes to reduce progression to the disease in a consensus statement on preventing the condition published this week by the International Diabetes Federation (IDF).

The consensus, developed by representatives from diabetes organisations from around the world, suggests that healthcare professionals should identify people at high risk of type-2 diabetes opportunistically.

It recommends using a check for risk factors including age, waist circumference, family history, cardiovascular history and medication history.

Individuals at high risk should then have their plasma glucose level measured.

In people with fasting plasma glucose of 6.1 to 6.9 mmol/l or more, a glucose tolerance test should be carried out.

The presence of impaired glucose tolerance and impaired fasting glucose indicates greatly increased risk of developing type-2 diabetes.

People at high risk of type-2 diabetes should be prioritised for lifestyle interventions, including advice on weight management, healthy eating and regular physical activity, to prevent progression to type-2 diabetes.

Professor Mike Kirby, a GP in Letchworth and visiting professor at the University of Hertfordshire, said the recommendations were achievable.

‘I think early detection is very important. Many GPs are already doing this opportunistically. In my practice we have been doing it for years, and our prevalence of type-2 diabetes is only 5 per cent,’ he said.

Preventing diabetes would re-quire some input of time and re-sources by practices, said Professor George Alberti, National Director for Emergency Access and the UK representative on the consensus group.

‘But it would save practices a lot of work further down the line if patients do not go on to develop diabetes,’ he added.

People with type-2 diabetes have a two- to four-fold increased risk of developing CHD compared to the rest of the population.

Their risk of cerebrovascular and peripheral vascular disease is also significantly higher.

At a wider level, the IDF consensus is calling on governments to make efforts to improve diet and physical activity.

The full paper will be published in the May issue of Diabetic Medicine.

Dr Martin Hadley-Brown, chairman of the Primary Care Diabetes Society, said: ‘The consensus statement that IDF has come up with is very much in line with policy of people with an interest in diabetes anyway. It’s being pushed for already.’

Screening at-risk patients for type-2 diabetes could be added to certain parts of the quality framework, he suggested.

‘It could be an addition to the IHD part of the framework. If there is going to be anything else about obesity, it could go in there,’ Dr Hadley-Brown said.

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