Diabetes
While not recommended as a general screen, screening for diabetes is recommended based on known risk factors.
This difficult-to-manage disease is now occurring with alarming frequency, affecting a younger age group and certain ethnic groups in particular. In the UK the prevalence of diabetes in the older age group is between two and five per cent, most having Type 2. It is likely that an equal number are undiagnosed. As many as 20 percent of Asians over the age of 40 have diabetes. Many who have the disease do not know it, and there is concern about the complications that can develop. Although many experts say that more data are needed to justify the cost and value of earlier and broader screening, some groups have amended their recommendations to address this growing health problem.
The NHS National UK Screening Committee policy position (March 2003) is that general population screening should not be offered except as part of a peer reviewed and ethically approved project.Diabetes UK lists high risk groups as including:
- Caucasian people aged over 40 years and people from black, Asian and minority ethnic groups aged over 25, with:
- a first degree family history of diabetes
- who are overweight and who have a sedentary lifestyle
- who have ischaemic heart disease, cerebrovascular disease, peripheral vascular disease or hypertension
- Women who have had Gestational diabetes (screen at one year post-partum and then three-yearly)
- Women with polycystic ovary syndrome who are obese
- Those known to have impaired glucose tolerance or impaired fasting glycaemia.
Diabetes UK currently recommends active case finding of those with increased risk of developing diabetes every three years.
For screening high risk groups for diabetes, venous glucose two hours after a glucose load is the best test, but fasting venous glucose or finger prick tests are alternatives. Urine testing for glucose is not recommended as it is not sensitive enough.
