Abstract
Type 2 diabetes is a serious chronic condition that may go undetected and therefore untreated for many years. Therefore many people with type 2 diabetes have complications present at diagnosis. Non-diabetic hyperglycaemia is a condition where blood glucose levels are elevated beyond normal but not high enough to be diagnosed with diabetes. Those with non-diabetic hyperglycaemia are at high risk of develo** type 2 diabetes. Data from robust clinical trials show that earlier treatment for type 2 diabetes may improve outcomes and that diabetes can be prevented in those with non-diabetic hyperglycaemia through lifestyle change; therefore, early identification is required. Uptake to routine health checks is low. Non-invasive risk assessments for diabetes offer a quick and easy way to detect those at high risk of these conditions and to target definitive testing whilst also engaging individuals with their risk factors. Such assessments use non-invasive risk factors to assess risk and can be used within routine care or opportunistically. Using such risk assessments is recommended by NICE to detect those at risk of diabetes.
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References
Diabetes UK. Diabetes in the UK 2010: Key statistics on diabetes. 2010.
IDF. Diabetes Atlas Eighth Edition. 2017. http://www.diabetesatlas.org/.
Harris MI, et al. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care. 1992;15(7):815–9.
Pierce MB, et al. Undiagnosed diabetes—data from the English longitudinal study of ageing. Diabet Med. 2009;26(7):679–85.
Griffin SJ, et al. Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial. Lancet. 2011;378(9786):156–67.
World Health Organisation. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Geneva: World Health Organisation; 2011.
Morris DH, et al. Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia. 2013;56(7):1489–93.
National Cardiovascular Intelligence Network (NCVIN). NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/456149/Non_diabetic_hyperglycaemia.pdf.
Gillies CL, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007;334:299.
Diabetes UK. The cost of diabetes. 2014. https://www.diabetes.org.uk/resources-s3/2017-11/diabetes%20uk%20cost%20of%20diabetes%20report.pdf.
Hex N, et al. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29(7):855–62.
Tunceli K, et al. The impact of Diabetes on employment and work productivity. Diabetes Care. 2005;28(11):2662–7.
American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033–46.
Nichols GA, Arondekar B, Herman WH. Medical care costs one year after identification of hyperglycemia below the threshold for diabetes. Med Care. 2008;46:287–92.
Herman WH. The economics of diabetes prevention. Med Clin. 2011;95(2):373–84.
Waugh N, et al. Screening for type 2 diabetes: literature review and economic modelling. Health Technol Assess. 2007;11(17):144.
Erlinger TP, Brancati FL. Postchallenge hyperglycemia in a national sample of U.S. adults with type 2 diabetes. Diabetes Care. 2001;24(10):1734–8.
Davidson MB, Peters AL, Schriger DL. An alternative approach to the diagnosis of diabetes with a review of the literature. Diabetes Care. 1995;18(7):1065–71.
Waugh N, et al. Screening for type 2 diabetes: a short report for the National Screening Committee. Health Technol Assess. 2013;17(35):1–90.
Gallagher EJ, Bloomgarden ZT, Roith D. Review of hemoglobin A1c in the management of diabetes. J Diabetes. 2009;1(1):9–17.
Herman WH, Ma Y, Uwaifo G. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the diabetes prevention program. Diabetes Care. 2007;30(10):2453–7.
Mostafa SA, et al. Independent effect of ethnicity on Glycemia in south Asians and white Europeans. Diabetes Care. 2012;35(8):1746–8.
Mostafa SA, et al. The potential impact of using glycated haemoglobin, HbA1c, as the preferred diagnostic tool for type 2 diabetes mellitus. Diabet Med. 2010;72:762–9.
Gray LJ, Khunti K. Type 2 diabetes risk prediction—do biomarkers increase detection? Diabetes Res Clin Pract. 2013;101(3):245–7.
Khunti K, et al. A comparison of cost per case detected of screening strategies for type 2 diabetes and impaired glucose regulation: modelling study. Diabetes Res Clin Pract. 2012;97(3):505–13.
Buijsse B, et al. Risk assessment tools for identifying individuals at risk of develo** type 2 diabetes. Epidemiol Rev. 2011;33(1):46–62.
Collins GS, et al. Develo** risk prediction models for type 2 diabetes: a systematic review of methodology and reporting. BMC Med. 2011;9:103.
Noble D, et al. Risk models and scores for type 2 diabetes: systematic review. BMJ. 2011;343:d7163.
Barber SR, et al. Risk assessment tools for detecting those with pre-diabetes: a systematic review. Diabetes Res Clin Pract. 2014;105(1):1–13. https://doi.org/10.1016/j.diabres.2014.03.007. Epub 2014 Mar 18.
Lindström J, Tuomilehto J. The Diabetes risk score. Diabetes Care. 2003;26(3):725–31.
Saaristo T, et al. Cross-sectional evaluation of the Finnish Diabetes risk score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome. Diab Vasc Dis Res. 2005;2(2):67–72.
Cos FX, et al. Screening for people with abnormal glucose metabolism in the European DE-PLAN project. Diabetes Res Clin Pract. 2015;109(1):149–56.
Al-Lawati JA, Tuomilehto J. Diabetes risk score in Oman: a tool to identify prevalent type 2 diabetes among Arabs of the Middle East. Diabetes Res Clin Pract. 2007;77(3):438–44.
Chien K, et al. A prediction model for type 2 diabetes risk among Chinese people. Diabetologia. 2009;52(3):443–50.
Glümer C, et al. Risk scores for type 2 Diabetes can be applied in some populations but not all. Diabetes Care. 2006;29(2):410–4.
Griffin SJ, et al. Diabetes risk score: towards earlier detection of type 2 diabetes in general practice. Diabetes Metab Res Rev. 2000;16(3):164–71.
Gray LJ, et al. The Leicester risk assessment score for detecting undiagnosed type 2 diabetes and impaired glucose regulation for use in a multiethnic UK setting. Diabet Med. 2010;27(8):887–95.
Gray LJ, et al. Detection of impaired glucose regulation and/or type 2 diabetes mellitus, using primary care electronic data, in a multiethnic UK community setting. Diabetologia. 2012;55(4):959–66.
Hippisley-Cox J, et al. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. Br Med J. 2009;388:b880.
Hippisley-Cox J, Coupland C. Development and validation of QDiabetes-2018 risk prediction algorithm to estimate future risk of type 2 diabetes: cohort study. BMJ. 2017;359:j5019.
Webb DR, et al. Rationale and design of the ADDITION-Leicester study, a systematic screening programme and randomised controlled trial of multi-factorial cardiovascular risk intervention in people with type 2 diabetes mellitus detected by screening. Trials. 2010;11:16.
Willis A, et al. A community faith centre based screening and educational intervention to reduce the risk of type 2 diabetes: a feasibility study. Diabetes Res Clin Pract. 2016;120:73–80.
Gray LJ, et al. External validation of two diabetes risk scores in a young UK South Asian population. Diabetes Res Clin Pract. 2014;104(3):451–8.
Dunkley AJ, et al. 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. Southampton (UK): NIHR Journals Library; 2017. (Programme Grants for Applied Research, No. 5.11).
Barber S, et al. Prospective validation of the Leicester/Diabetes UK risk assessment for diagnosis of Type 2 diabetes. In Diabetes UK. Glasgow: Diabetic Medicine; 2016.
Chatterton H, et al. Risk identification and interventions to prevent type 2 diabetes in adults at high risk: summary of NICE guidance. BMJ. 2012;12(345):e4624.
Patel N, et al. Develo** a conceptually equivalent type 2 diabetes risk score for Indian Gujaratis in the UK. J Diab Res. 2016;2016:9.
Hippisley-Cox J, Coupland C, Brindle P. The performance of seven QPrediction risk scores in an independent external sample of patients from general practice: a validation study. BMJ Open. 2014;4(8):e005809.
Collins GS, Altman DG. External validation of QDSCORE® for predicting the 10-year risk of develo** type 2 diabetes. Diabet Med. 2011;28(5):599–607.
National Cardiovascular Intelligence Network (NCVIN). NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Public Health England. 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/456149/Non_diabetic_hyperglycaemia.pdf.
Robson J, et al. The NHS health check in England: an evaluation of the first 4 years. BMJ Open. 2016;6(1):e008840.
Smith S, Waterall J, Burden ACF. An evaluation of the performance of the NHS health check programme in identifying people at high risk of develo** type 2 diabetes. BMJ Open. 2013;3(3):e002219.
NICE. Type 2 diabetes: prevention in people at high risk. Public health guideline [PH38]. 2017.
Sandbaek A, et al. Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study. Diabetologia. 2008;51(7):1127–34.
Tao L, et al. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial. Diabet Med. 2015;32(7):907–19.
Sandbæk A, et al. Effect of early multifactorial therapy compared with routine care on microvascular outcomes at 5 years in people with screen-detected diabetes: a randomized controlled trial. The ADDITION-Europe Study. Diabetes Care. 2014;37(7):2015–23.
Herman WH, et al. Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: a simulation of the results of the Anglo-Danish-Dutch study of intensive treatment in people with screen-detected diabetes in primary care (ADDITION-Europe). Diabetes Care. 2015;38(8):1449–55.
Gillies CL, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007;334:299.
Knowler WC, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
Troughton J, et al. Development of a lifestyle intervention using the MRC framework for diabetes prevention in people with impaired glucose regulation. J Public Health (Oxf). 2016;38(3):493–501. Epub 2015 Aug 25.
Davies MJ, et al. A community based primary prevention programme for type 2 diabetes integrating identification and lifestyle intervention for prevention: the let’s prevent Diabetes cluster randomised controlled trial. Prev Med. 2016;84:48–56.
Gray LJ, et al. Engagement, retention, and progression to type 2 diabetes: a retrospective analysis of the cluster-randomised “Let’s Prevent Diabetes” trial. PLoS Med. 2016;13(7):e1002078.
Leal J, et al. Cost-effectiveness of a pragmatic structured education intervention for the prevention of type 2 diabetes: economic evaluation of data from the let’s prevent diabetes cluster-randomised controlled trial. BMJ Open. 2017;7(1):e013592.
Lascar N, et al. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69–80. https://doi.org/10.1016/S2213-8587(17)30186-9. Epub 2017 Aug 25.
Dabelea D, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–86.
Holden S, et al. The incidence of type 2 diabetes in the United Kingdom from 1991 to 2010. Diabetes Obes Metab. 2013;15(9):844–52.
Candler TP, et al. Continuing rise of type 2 diabetes incidence in children and young people in the UK. Diabet Med. 2018;35(6):737–44.
Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234–44.
Wilmot EG, et al. Prevalence of diabetes and impaired glucose metabolism in younger ‘at risk’ UK adults: insights from the STAND programme of research. Diabet Med. 2013;30(6):671–5.
The Lancet. Type 2 diabetes: the urgent need to protect young people. Lancet. 2018;392.
Eborall H, et al. Patients’ experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007;335(7618):490.
Willis AW. The effectiveness of screening for type 2 diabetes within a community pharmacy setting, in Department of Health Sciences. University of Leicester; 2015.
Twigg MJ, et al. Community pharmacy type 2 diabetes risk assessment: demographics and risk results. Int J Pharm Pract. 2015;23(1):80–2.
George PM, et al. Screening for type 2 diabetes in the accident and emergency department. Diabet Med. 2005;22(12):1766–9.
Gomez-Peralta F, et al. Point-of-care capillary HbA1c measurement in the emergency department: a useful tool to detect unrecognized and uncontrolled diabetes. Int J Emerg Med. 2016;9(1):1–6.
Hng T-M, et al. Diabetes case finding in the emergency department, using HbA1c: an opportunity to improve diabetes detection, prevention, and care. BMJ Open Diabetes Res Care. 2016;4(1).
NHS Dental Statistics. NHS Dental Statistics for England, 2017–18, Second quarterly report. NHS Digital 2018.
Preshaw PM, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21–31.
Lalla E, et al. Identification of unrecognized diabetes and pre-diabetes in a dental setting. J Dent Res. 2011;90(7):855–60.
AlGhamdi AST, et al. Dental clinics as potent sources for screening undiagnosed diabetes and prediabetes. Am J Med Sci. 2013;345(4):331–4.
Genco RJ, et al. Screening for diabetes mellitus in dental practices: a field trial. J Am Dent Assoc. 2014;145(1):57–64.
Yonel Z, et al. Patients’ attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study. BMJ Open. 2018;8(11):e024503.
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Gray, L.J. (2020). Risk Assessment for Diabetes. In: Chapple, I., Papapanou, P. (eds) Risk Assessment in Oral Health. Springer, Cham. https://doi.org/10.1007/978-3-030-38647-4_5
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DOI: https://doi.org/10.1007/978-3-030-38647-4_5
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