A study conducted by researchers from the University of Exeter, UK, suggests utilizing standard diabetes tests for all UK adults between the ages of 40 and 70 could lead to earlier detection of Type 2 Diabetes, enabling early intervention.
The study, published in Diabetologia, is the first to use real-world data to assess the impact of diabetes screening on the time to diagnosis in a large population cohort, using data from the UK Biobank.
The authors analyzed UK Biobank participants aged 40–70, focusing on the levels of HbA1c—a marker reflecting blood sugar control over the past 2-3 months.
The participants’ HbA1c results were not disclosed to them or their doctors. Among 179,923 participants with linked healthcare data, 13,077 had a pre-existing diabetes diagnosis, and 1,703 participants had undiagnosed diabetes based on their HbA1c at enrolment.
Approximately 1.0% of the participants had undiagnosed diabetes, suggesting that up to 250,000 adults in this age group in the UK have undiagnosed diabetes that could be detected by HbA1c-based screening.
The median time to clinical diagnosis for those with undiagnosed diabetes was 2.2 years.
Women with lower HbA1c and BMI experienced the longest delay to clinical diagnosis, implying a prevailing tendency to screen men or those with obesity more frequently.
By 10 years of follow-up, 88% of the 1,703 undiagnosed cases had received a clinical diagnosis.
Implications and Challenges
The implementation of standard diabetes tests could significantly reduce the time to diagnosis and allow for earlier intervention.
However, the utility of such screening initiatives could face limitations due to the healthier and more health-conscious demographic of the UK Biobank participants and underrepresentation of ethnic minorities, who have higher rates of diabetes.
Furthermore, the cost-effectiveness of a population-wide screening, and the changes in healthcare utilization and testing due to the COVID-19 pandemic and economic pressure on healthcare spending, represent substantial challenges.
Recommendations and Conclusion
The authors emphasize the crucial need for enhanced awareness among healthcare professionals regarding the importance of diabetes checks in people without obesity and those not deemed ‘high risk’ based on existing risk scores.
They also underscore the importance of improved diabetes risk scores and advocate for the increased relevance of diabetes screening initiatives to prevent extensive delays in diagnosis amidst prevailing healthcare challenges.
This study serves as a stepping stone towards understanding the pivotal role of early diagnosis through population-level screening, potentially leading to timely interventions and reduced risk of diabetes complications, but further evaluations are needed to assess the overall impact and feasibility of such initiatives in varied population subsets.
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The research findings can be found in Diabetologia.
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