Diagnosing type 2 diabetes and identifying high-risk individuals using the new glycated haemoglobin (HbA1c) criteria

Gholap, Nitin; Davies, Melanie J.; Mostafa, Samiul; Khunti, Kamlesh

doi:10.3399/bjgp13x663244

Cited by 17 publications

(8 citation statements)

References 11 publications

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“…[4] The challenge is to prevent complications associated with IFG of which ∼30% will remain undiagnosed for a significant period of time. [5] The International Diabetes Federation have recognized the importance of the traditional biomarkers (general biochemistry): blood glucose (BGL), haemoglobin A1c (HbA1c), and lipid studies along with life style improvement and drug treatment regimens to combat T2DM and CVD. There is also a recognition that lower blood glucose levels (<7.8 mmol/l) have lower rates of all major end point diabetic complications.…”

Section: Introductionmentioning

confidence: 99%

Hyperglycaemia, oxidative stress and inflammatory markers

Butkowski

Jelinek

2016

Redox Report

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Section: Introductionmentioning

confidence: 99%

Hyperglycaemia, oxidative stress and inflammatory markers

Butkowski

Jelinek

2016

Redox Report

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“…27,28 The potential benefits of the HbA 1c test include it being a non-fasting blood test, less inter-test variability and its ability to provide an indication of longer-term hyperglycaemia (over 6-8 weeks). 29 A HbA 1c level of ≥ 48 mmol/l (6.5%) is suggestive of T2DM, whereas a level of 42-47 mmol/l (6.0-6.4%) is suggestive of IGR or a high risk of diabetes. 27 Further details on the methods used to identify T2DM and IGR for this programme of research are provided in Chapter 5 (see Outcomes) and Chronic conditions are becoming increasingly important for people with ID as their life expectancy increases.…”

Section: Type 2 Diabetes and Impaired Glucose Regulationmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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“…6 This two-stage approach initially involves an assessment using a computer based validated risk assessment score (Leicester or Cambridge) of all persons over 40 years (and those over 25 years in known high risk groups). The Leicester group, 7 in this issue of the BJGP offers a practical scheme for doing this in a busy general practice, a process greatly simplified by the use of risk assessment scores, and measurement of HbA1c rather than fasting blood glucose tests. People identified as being in the top 50% of diabetes risk using a computer-based risk assessment tool, can be opportunistically offered a HbA1c test to identify those with diabetes and those at high risk who require intensive structured lifestyle intervention and annual HbA1c monitoring.…”

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confidence: 99%

Type 2 diabetes: prevention and cure?

Pierce

2013

Br J Gen Pract

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General practice in the UK has been very successful in meeting the challenges raised by increasing prevalence of diabetes. Most diabetes is now managed in general practice and disease registers, evidencebased care, diabetes clinics, and diabetes trained practice nurses are now routine.As a consequence of the obesity epidemic, and the ageing population, diabetes rates are rising, and diabetes can remain undiagnosed for many years. GPs have made progress in recent years in identifying previously undiagnosed cases. Recent population-based reports suggest that only 3% of men and 1% of women over 50 years have undiagnosed diabetes.

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Diagnosing type 2 diabetes and identifying high-risk individuals using the new glycated haemoglobin (HbA1c) criteria

Cited by 17 publications

References 11 publications

Hyperglycaemia, oxidative stress and inflammatory markers

Hyperglycaemia, oxidative stress and inflammatory markers

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Type 2 diabetes: prevention and cure?

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