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DM II screening program

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  • 15-01-2010 6:32pm
    #1
    Sitric
    Registered Users Posts: 234 ✭✭


    Hi,

    Do we have a national program for screening type II diabetes?

    If people are diagnosed on the basis of chronic complications, they have most likely had poorly controlled glycemia for a period of years. I know GP's will screen risk groups but would a coordinated national program (for e.g. all people over 50?) allowing earlier, presymptomatic detection be feasible? Would it save a lot of money in terms of treatment costs? And more importantly would it prevent significant levels of chronic complications?

    Obviously it would take a lump of money to establish.


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    #2
    Vorsprung
    Registered Users Posts: 2,815 ✭✭✭Vorsprung


    Sitric wrote: »
    Hi,

    Do we have a national program for screening type II diabetes?

    If people are diagnosed on the basis of chronic complications, they have most likely had poorly controlled glycemia for a period of years. I know GP's will screen risk groups but would a coordinated national program (for e.g. all people over 50?) allowing earlier, presymptomatic detection be feasible? Would it save a lot of money in terms of treatment costs? And more importantly would it prevent significant levels of chronic complications?

    Obviously it would take a lump of money to establish.

    Chronic complications are usually due to poor compliance with meds or diet, or poor glycaemic control, rather than late detection. There's a lot of opportunistic screening done by GPs and among hospital in-patients (in the form of a fasting glucose), but a quick google search shows that there's been a few studies in recent years suggesting HbA1c (which measures that amount of sugar attached to haemoglobin, giving an idea of how high or low sugars had been in the previous 90 days) as a screening test:

    HbA1c useful?

    Fasting glucose not much use?

    I don't know what the current guidelines are, but I haven't heard of calls to start a national screening programme (that usually signals that there's a new study out saying it's cost-effective)

    A good way of reducing complications is education - there's a programme called DAFNE which I know is run in Loughlinstown, but I'm sure in other hospitals too, which educates people on doses of insulin for particular meals. Haven't got a study to hand, but the consultant who ran it told my class that it reduced complications by a good bit.


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    #3
    Sitric
    Registered Users Posts: 234 ✭✭Sitric


    Thanks for that.

    I agree completely, education and compliance with treatment gives someone the best shot at preventing the development of complications. And glycosylated Hb may be better than fasting plasma glc but there is uncertainty about it's value before the development of frank DM. It may not be raised significantly in borderline Glc intolerance. It definitely gives you a broader picture of the previous 120 days though.

    However, I am sure the are many people who are relatively asymptomatic for years before detection due to a complication.

    Can't link to what I was reading that prompted the question but it's chapter 338, pp 2275-2300 in Harrisons. Was just checked what i'd heard in a lecture about the level of people fitting the criteria for diagnosis who are without symptoms and unaware that they have the disease.

    The complications of DM take a number of years to develop, in the talk he gave the figure of +7 yrs with a minimum of +5yrs of uncontrolled glycemia before the presentation of angiopathy/neuropathy/nephropathy etc and it's quite possible to be unaware that you have the disease for this period if you don't happen to have a FPG for another reason.

    If you began screening in 40's, you would have a low level of detection in the the earlier age bands but I think you would find some people and this would increase rapidly as you moved up the age bands.

    Possibly this is redundant and sufficient people are tested by the GP's for one reason or another to make a screening program unnecessary.

    EDIT

    Specifically what they say in Harrisons is:

    Large numbers of people meeting the criteria for DM are asymptomatic and unaware they have the disease

    epidemiological studies show that DM-II may be present for up to a decade before diagnosis

    As many as 50% of individuals with DM-II have one or more diabetes specific complications at the time of their diagnosis

    Treatment of DM-II may favourably alter the natural history of DM


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