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Irish diabetes detection programme in general practice.

S M Smith1, J Holohan, A McAuliffe

  • 1UCD Department of Community Health and General Practice, Trinity College Dublin, Dublin, Ireland. susmith@tcd.ie

Diabetic Medicine : a Journal of the British Diabetic Association
|August 20, 2003
PubMed
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Opportunistic screening in Irish general practices identified a high prevalence of undiagnosed diabetes and glucose intolerance. Utilizing a multi-step approach including questionnaires, random plasma glucose, and oral glucose tolerance tests is feasible and effective.

Area of Science:

  • Endocrinology and Metabolic Diseases
  • Primary Care and Public Health

Background:

  • Undiagnosed diabetes mellitus (DM) and prediabetes (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) pose significant public health challenges.
  • Opportunistic screening in primary care settings can identify individuals at risk for glucose metabolism disorders.
  • Effective screening strategies are needed to detect these conditions early in populations over 40 years.

Purpose of the Study:

  • To determine the prevalence of undiagnosed diabetes, IFG, and IGT in patients aged over 40 attending general practitioners (GPs) in Ireland.
  • To evaluate the feasibility and effectiveness of a three-step opportunistic screening tool for diabetes detection.

Main Methods:

  • A three-step screening process was implemented in 41 Irish general practices.

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  • It involved a screening questionnaire for diabetes risk factors and symptoms, followed by random venous plasma glucose (RVPG) measurement.
  • Oral glucose tolerance tests (GTTs) were performed for individuals with RVPG levels above 5.5 mmol/l.

    • Main Results:

    • The study screened 3821 patients, revealing a 9.2% prevalence of Type 2 diabetes mellitus, with 23.5% of these cases being previously undiagnosed.
    • The prevalence of IFG and/or IGT was 3.9%.
    • The GTT identified 1.3% of the population with diabetes and was crucial for detecting 81% of individuals with IGT, who might have been missed by fasting glucose tests alone.

    Conclusions:

    • Opportunistic screening using a questionnaire, RVPG, and GTT in general practice is a feasible and effective strategy for identifying diabetes and glucose intolerance.
    • The oral glucose tolerance test significantly improves the detection of impaired glucose tolerance, identifying individuals at higher cardiovascular risk.
    • This multi-step screening approach enhances patient identification for timely intervention.