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Detecting diabetes

Diabetes Tools PDF

Full colour PDF of “Detecting Diabetes”.
 Printer friendly PDF.
Powerpoint presentation/summary.

About this resource

There has been a marked improvement in diabetes detection over the last few years, thanks to the efforts of general practice. We are now at the point of trying to detect diabetes in people who have not been reached through traditional approaches. Identifying these people will probably require an additional targeted effort aimed at overcoming barriers to accessing primary care. This resource contains a toolkit of ideas to help you address some of these barriers.

Background

In New Zealand there are now approximately 170, 000 people1 diagnosed with diabetes – 155,000 with type 2 diabetes and 15,000 people with type 1 diabetes. The overall prevalence of diabetes is about 5% although there are ethnic differences. In New Zealand, diabetes is less prevalent in European (4.3%) compared with Māori (5.8%), Asian (6.5%) and Pacific people (10.0%).2

We frequently hear that “for every known case of diabetes there is another undiagnosed in the community”. However, the Diabetes Heart and Health survey3 has recently determined:

  • For every two European people with previously diagnosed diabetes there is approximately one in the community undiagnosed,
  • For every three Māori people diagnosed there was one Māori person undiagnosed and
  • For every five Pacific people with diagnosed diabetes there was just over one Pacific person undiagnosed.

The results of the survey suggests diabetes screening for Māori and Pacific people has improved considerably over the past decade.

One of the main benefits of identifying people with diabetes, impaired glucose tolerance or impaired fasting glycaemia is that it provides opportunity for intervention which may delay the onset of diabetes and it’s complications. The Finnish Diabetes Prevention study demonstrated lifestyle interventions were able to decrease the incidence of progression to type 2 diabetes in people with prediabetes.4 The study focused on goals related to weight, diet and physical activity and it demonstrated that the progression to diabetes was inversely associated with the number of behaviour goals for prevention that were met. In another study, similar goals were applied to a large cohort of the general population, living in Norfolk, UK. In those who met all the healthy behaviour goals, none went on to develop diabetes.5 The Ngati and Healthy study utilised similar culturally competent approaches and has shown a marked decrease in insulin resistance amongst 25-49 year-old women and men.7

To identify those at risk, targeted testing of at risk people remains the most practical and cost effective approach. Population wide screening for type 2 diabetes is not recommended and this has recently been reiterated by the US Preventive Services Task Force who have stated they do not recommend screening in asymptomatic individuals without risk factors.6

Overcoming barriers

New Zealand general practitioners are aware of the global epidemic of diabetes, and the increasing burden this will place on healthcare resources within New Zealand.

Most New Zealand GPs are aware of which of their patients are at high risk of diabetes, and how to test them. But confirming the diagnosis is not always easy due to a number of obstacles facing both GPs and patients. Although research has shown marked improvement over the last ten years for diabetes testing in New Zealand, there is still a portion of people who remain undiagnosed. This resource is designed to help overcome the barriers, so these people can be identified.

While some barriers are common to many practices, others are unique due to factors such as practice demographics, location and deprivation.

As a result, methods for overcoming these barriers can not be prescriptive – solutions need to be as individual as the issues each practice faces.

This resource is designed as a series of tools, developed by bpac, to help each practice identify the issues specific to them and then ensuring these are managed appropriately.

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