A
New Two-Step Screening Protocol for Type 2 Diabetes
OGTT
was not required to identify the large majority of diabetic patients
in this two-step screening procedure."
A
two-step screening protocol for type 2 diabetes, which incorporates
both universal screening and screening tests targeted to high-risk
subjects, has been well received by the general population in the
Netherlands, researchers report in the October issue of Diabetes Care.
Early
diagnosis of type 2 diabetes has not been conclusively proven to be
important, Dr. Annemieke M. W. Spijkerman and colleagues maintain.
Noting that screening benefits only a small number of the people
involved, they argue that the initial screening test should be
noninvasive.
Accordingly,
the research team, which is based at VU University Medical Center in
Amsterdam, mailed the Symptom Risk Questionnaire (SRQ) to 11,679
residents of three Dutch municipalities. Altogether, 9169 individuals
returned the SRQ or a form explaining why they did not feel a need to
participate, for a total response rate of 78%.
The
3301 respondents with an SRQ score >6 were invited to undergo
fasting blood glucose measurement, and 2885 accepted. Of these, 570
had glucose levels between 5.5 and 8.5 mmol/L and were offered a 75-g
oral glucose tolerance test (OGTT). Of the 473 people who underwent
the test, 217 were diagnosed with type 2 diabetes.
The
diagnosed patients had relatively low hemoglobin A1c (HbA1c) levels, a
mean of 6.7%, according to the report. About 70% had hypertension,
about one third had high triglyceride and/or low HDL cholesterol
levels, and 73% had a high cholesterol level. "One could argue
that our screening procedure identified diabetic patients who might
benefit most from early treatment of dyslipidemia and
hypertension," the researchers remark.
They
note that 36 patients had fasting glucose levels >8.5 mmol/L and
were diagnosed on the basis of a second fasting glucose test, instead
of the OGTT. These patients "were relatively young, had high
HbA1c levels, and frequently reported thirst and a family history of
diabetes on the SRQ," the team explains. "We expect that
these patients would...have come to rapid clinical recognition without
the screening."
The
only diabetics who would not have been identified if the OGTT had been
omitted were 29 individuals who were diagnosed on the basis of a
2-hour plasma glucose level of at least 11.1 mmol/L. "These
results seem to imply," the researchers conclude, "that the
OGTT added relatively few cases and may not be required to identify
the large majority of diabetic patients in this two-step screening
procedure."
Diabetes
Care 2002;25:1784-1789.
===========================
Join
Diabetes in Control.com for this two-day conference regarding how
to establish diabetes-related programs and services to enhance
treatment and quality of care. Hear case studies from such
leaders in diabetes treatment and care as Mercy Medical Diabetes
Center, the CDC and Columbia Presbyterian. Attendance at this
event will ensure that you can return to your facility with the tools
to improve or newly create a Diabetes Care Center. Mention
Diabetes in Control.com and receive $300 off the regular attendee
price. Call Elizabeth Hutchison at 312-780-0700, ext. 179, or
write ehutchison@acius.net
for discount and agenda information.
Click
her for more info: Diabetes Care Centers
