Screening for Diabetes

Indications for screening

Symptomatic patients with any of the following are regularly screened

  1. Related conditions
    • IHD, HTN, Hyperlipidaemia
    • ‘Diabetic precursors’
      • Gestational diabetes – screened yearly
      • Impaired Glucose Tolerance
    • PCOS
    • Those on steroid therapy long-term
    • Patients on atypical antipsychotics
  2. Symptomatic patients – see Clinical features of diabetes
    • Polydipsia/Polyuria
    • Recurrent infections
    • Weight loss
    • Tiredness
    • Urinary incontinence
    • Signs of peripheral neuropathy or retinopathy
The NHS Health Check System
  • Screening asymptomatic patients is done as part of the  NHS health check system
    • This is a national risk assessment programme
    • (See best practice guidelines for detail)

 

  • Eligibility for screening:
    • All adults 40-73 years old without a pre-existing condition are offered screening
  • This system screens for 5 conditions :
    1. T2DM
    2. IHD
    3. Stroke
    4. CKD
    5. Dementia (for those >60)
    • NB not HTN specifically
  • Methodology:
    • Done by GP
    • Steps:
      1. Identify whether the patient is at high-risk  (screening tools are available)
        • BMI >30 (use instead 25 if Asian)
        • People with signs of diabetic disease
          • E.g. retinopathy, kidney disease, neuropathy
          • BP >140/90
        • People with associated conditions
          • PCOS
          • NAFLD
          • Women with past gestational diabetes
      2. Glucose testing is done in high-risk patients only
        • HBA1c is recommended over OGTT/fasting glucose but both can be used
        • Random glucose tests should not be used at all for screening/diagnosis
      3. Once this is done:
        • Further investigations for complications etc can be carried out
        • Treatment can be delivered
  • Separate assessments are done for the other conditions