Diabetes Screening in Canada (DIASCAN) Study

Abstract

OBJECTIVE -To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals Ն40 years of age who contacted their family physician for routine care.RESEARCH DESIGN AND METHODS -The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients Ն40 years of age were screened for diabetes. If a casual fingerprick blood glucose was Ͼ5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories.RESULTS -Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS -Routine screening for diabetes by family physicians is justified in patients Ն40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients Ն40 years of age have known diabetes. This has important implications regarding health resources and physician education.

Magnitude of Pre-Diabetes among Adult Nigerians with Essential Hypertension in a Primary Care Clinic of a Tertiary Hospital in South-Eastern, Nigeria

“…This is higher than 25% reported among hypertensive patients in Enugu, Nigeria [7] and 3.5% reported among primary care patients in Canada. [13] The prevalence of pre-diabetes in this study is lower than 39.1% reported in Calabar, Nigeria [28] and 43% reported in Nepal. [18] However, the prevalence of pre-diabetes of 33.1% in this study is within the range of 25.0% -47.0% reported in the European Study of Hypertension and Diabetes.…”

“…[23] The earlier in the pre-morbid phase that pre-diabetes is detected in adult hypertensive patients, the better the prognosis and outcome of its management. [11][12][13] Establishing a baseline for the blood glucose and checking them during patients visits appropriately can provide the clinicians with an excellent means of educating their hypertensive patients on lifestyle modifications and other diverse clinical care.…”

“…In Canada, a prevalence of pre-diabetes of 3.5% was reported among primary care patients. [13] Shuqian et al, [17] in a study on the prevalence of diabetes mellitus and IFG in Chinese adults found an IFG prevalence of 4.9%. Shrestha et al, [18] reported a prevalence of 43% among hypertensive patients in urban Nepal.…”

“…Although individuals with impaired fasting glucose and/or impaired glucose tolerance do not meet criteria for Diabetes mellitus, they are at substantial risk for developing Diabetes mellitus and cardiovascular diseases. [10,12,13] As the prevalence of Diabetes mellitus increases worldwide, [1,13] so will the prevalence of pre-diabetes increase since the latter is a phase in the natural history of Diabetes mellitus. [6,7] In United States of America, a prevalence of pre-diabetes of 25% was reported in US adults and only 4% of them were aware of the medical condition.…”

Screening for type 2 diabetes: literature review and economic modelling

“…69 Screening was sequential -a casual BG; those with results over 5.5 mmol/l were asked to return for an FPG; those with FPG 6.1-6.9 mmol/l were invited back for a 2-hour post-glucose load sample. However, screening was offered only to those who attended for routine care for other reasons, who by definition are less healthy than the rest of the population, and may be at higher risk.…”