BMJ 2001;323:548-551 ( 8 September )

Primary care

Screening for diabetes in general practice: cross sectional population study

James M Lawrence, specialist registrar, a Paul Bennett, general practitioner principal, b Alan Young, general practitioner principal, b Anthony M Robinson, consultant in diabetes and endocrinology. a

a Department of Diabetes and Endocrinology, Royal United Hospital, Bath BA1 3NG, b Batheaston Medical Centre, Batheaston, Bath BA1 7NP

Correspondence to: J Lawrence mpsjml{at}bath.ac.uk

Objective: To assess the policy proposed by the American Diabetes Association of universal screening in general practice of all patients aged over 45 years for diabetes.
Design: Cross sectional population study.
Setting: Local general practice in the United Kingdom.
Participants: All patients aged over 45 not known to have diabetes.
Main outcome measures: Prevalence of diabetes in the screened population, cardiovascular risk profile of patients diagnosed as having diabetes after screening.
Results: Of 2481 patients aged over 45 and not known to have diabetes, 876 attended for screening. There were no significant demographic differences between the screened and unscreened patients. Prevalence of diabetes in patients with age as a sole risk factor was 0.2% (95% confidence interval 0% to 1.4%). Prevalence of diabetes in patients with age and one or more other risk factors (hypertension, obesity, or a family history of diabetes) was 2.8% (1.6% to 4.7%). Four hours a week for a year would be needed to screen all people over 45 in the practice's population; about half this time would be needed to screen patients with risk factors other than age. More than 80% of patients newly diagnosed as having diabetes had a 10 year risk of coronary heart disease >15%, 73% (45% to 92%) were hypertensive, and 73% (45% to 92%) had a cholesterol concentration >5 mmol/l.
Conclusions: Screening for diabetes in general practice by measuring fasting blood glucose is feasible but has a very low yield in patients whose sole risk factor for diabetes is age over 45. Screening in a low risk population would best be targeted at patients with multiple risk factors.


What is already known on this topic
Between a third and a half of cases of diabetes are undiagnosed at any one time

New cases can be identified by screening groups of patients at risk

The American Diabetes Association has proposed the screening of all patients aged over 45 every three years

What this study adds
Screening for diabetes in general practice by measuring fasting blood glucose is feasible but requires much staff time

Screening solely on the basis of age has a very low yield and screening would best be targeted at patients with multiple risk factors for diabetes



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Rapid Responses:

Read all Rapid Responses

Pragmatic screening
Alexander Williams
bmj.com, 7 Sep 2001 [Full text]
Population screening for Diabetes IS cost effective
Nigel Higson
bmj.com, 9 Sep 2001 [Full text]
Screening for diabetes in developing countries.
V M Verma
bmj.com, 9 Sep 2001 [Full text]
Screening yield may not be quite so low.
Mary Walker
bmj.com, 12 Sep 2001 [Full text]
Opportunistic screening for diabetes in general practice better than nothing at all
Bertil Hagström
bmj.com, 17 Oct 2001 [Full text]
Cheap Diabetic Screening
Philip Ramage
bmj.com, 18 Oct 2001 [Full text]
Diabetes screening in general practice
Mel Bates
bmj.com, 10 Nov 2001 [Full text]
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