Identifying undiagnosed type 2 diabetes

Kamlesh Khunti, Laura Gray, David Shepherd, Melanie Davies
University of Leicester, Diabetes Research Unit

Identifying undiagnosed type 2 diabetes

Type 2 diabetes is one of the commonest long-term conditions globally with over 2.5 million cases in the UK alone. It is preceded by a pre-diabetic high risk state (sometimes called pre-diabetes), from which the progression to diabetes is more likely, but not inevitable. Because these conditions are often asymptomatic, many cases remain undiagnosed and therefore, untreated. Population-based screening studies have revealed that one in five of the population have either undiagnosed type 2 diabetes or are at high risk of developing diabetes in the future.

The Leicester Diabetes Practice Risk Score was developed by researchers within the Diabetes Research Centre at the University of Leicester and is recommended by NICE for the identification of those at risk of diabetes. The score was developed using data from the ADDITION-Leicester screening project and it identifies people who may be at high risk of diabetes or currently have undiagnosed type 2 diabetes using data on age, sex, BMI, ethnicity, family history of diabetes and anti-hypertensive use. The score was externally validated using data from a second screening study from the same area, the development and validation of the score has been published in Diabetologia.

Allowing easy implementation in clinical practice, the Leicester Diabetes Practice Risk Score:

  • Calculates the risk score for all those aged 40-75 years old (excluding those with known diabetes, the terminally ill and those coded with gestational diabetes) using the data stored within the practices electronic medical records.
  • Analyses any existing OGTT/HbA1c/glucose data as many people will have been screened already and also to identify anyone who may have existing diabetes which has been missed.
  • Outputs data to an Excel spread sheet which enables you to rank those stored within your practice records by diabetes risk.

Once you have the output data, it can allow you to invite those at greatest risk for screening, for example, you could initially invite those within the top 10% in your practice.

The risk score software has been used within practices around Leicester and Leicestershire as part of an NIHR programme grant. Those in the top 10% at risk within each were invited for screening with an OGTT. Of those screened 25.5% were found to be at high risk of diabetes and 4.5% had undiagnosed type 2 diabetes. These results were significantly higher than carrying out population-based screening. Utilising a risk score also lowers the cost per case detected. Identification of those at high risk allows for prevention programmes to be commenced and early identification of type 2 diabetes may reduce complications through earlier treatment.

The Leicester Diabetes Practice Risk Score software is freely available. A user guide has been developed which gives detailed instructions on how to download and use the risk score. For further information and to download the user guide and software, click here.

This work won Gold at the Quality in Care for Diabetes 2011 awards in the Best Screening and Early Detection category.

References [WORD]

 

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