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)

1. • 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