Feasibility of opportunistic screening for type 2 diabetes mellitus: Need for interventions to improve follow up

 

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Abstract

Objective: To determine the feasibility of opportunistic screening for type 2 diabetes (T2DM) among adult attendees of medicine outpatient department (OPD) at a tertiary care hospital in Puducherry district, India. Materials and Methods: A hospital-based cross-sectional study was conducted among nonpregnant nondiabetic adults above 30 years of age attending MOPD to screen for diabetes mellitus (DM). Those with random blood glucose of 6.1 mM/l or more were sent for definitive tests; fasting plasma glucose and post prandial (PP) plasma glucose. Double data entry and validation was done. Results: A total of 510 outpatients were tested for random blood glucose: 278 (54.5%) had blood glucose above the cut off. Out of 278, 83 (29.9%) returned for definitive tests: 18 [21.7%, 0.95 CI: 14.2%, 31.7%] had either fasting plasma glucose and/or PP plasma glucose in diabetic range and 16 (19.3%, 0.95 CI: 12.2%, 29.1%) had impaired fasting glucose and/or impaired glucose tolerance. Case detection (screening yield) of diabetes in the adult outpatients was 3.5% (0.95 CI: 2.2%, 5.5%). Conclusion: Compliance or follow-up for definitive tests was poor resulting in low screening yield. Future studies should focus on interventions to improve follow up of outpatients.

• References

• 1 Zeitz PS, Harrison LH, Lopez M, Cornale G. Community health worker competency in managing acute respiratory infection of childhood in Bolivia. Bull Pan Am Health Organ 1993; 27: 109-119
  PubMedGoogle Scholar
• 2 Mohan V, Deepa M, Deepa R, Shanthirani CS, Farooq S, Ganesan A. et al. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India — the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia [Internet] 2006; 49: 1175-1178 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16570158 [Last accessed on 2013 Dec 3].
  CrossrefPubMedGoogle Scholar
• 3 Chatterjee R, Narayan KM, Lipscomb J, Phillips LS. Screening adults for pre-diabetes and diabetes may be cost-saving. Diabetes Care [Internet] 2010; 33: 1484-1490 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2890345&tool=pmcentrez&rendertype=abstract [Last accessed on 2013 Dec 3].
  CrossrefPubMedGoogle Scholar
• 4 Pereira GrayDJ, Evans PH, Wright C, Langley P. The cost of diagnosing Type 2 diabetes mellitus by clinical opportunistic screening in general practice. Diabet Med [Internet] 2012; 29: 863-868 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22313143 [Last accessed 2013 Dec 3].
  CrossrefPubMedGoogle Scholar
• 5 Ramachandran A, Snehalatha C, Vijay V, Colagiuri S. Detecting undiagnosed diabetes in urban Asian Indians--role of opportunistic screening. J Assoc India [Internet] 2004; Jul 52: 545-546 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15645978 [Last accessed on 2013 Nov 25].
  Google Scholar
• 6 Klein WoolthuisEP, De Grauw WJ, Van Weel C. Opportunistic screening for type 2 diabetes in primary care. Lancet [Internet] 2010; 376: 683-684 Available from: http://www.thelancet.com/journals/a/article/PIIS0140-6736%2810%2961332-3/fulltext [Last accessed on 2013 Dec 3].
  PubMedGoogle Scholar
• 7 Li R, Zhang P, Barker LE, Chowdhury FM, Zhang X. Cost-effectiveness of interventions to prevent and control diabetes mellitus: A systematic review. Diabetes Care [Internet] 2010; 33: 1872-1894 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2909081&tool=pmcentrez&rendertype=abstract [Last accessed on 2013 Nov 14].
  CrossrefPubMedGoogle Scholar
• 8 Ealovega MW, Tabaei BP, Brandle M, Burke R, Herman WH. Opportunistic screening for diabetes in routine clinical practice. Diabetes Care [Internet] 2004; 27: 9-12 Available from: http://www.ncbi.nlm.nih.gov/pubmed/14693958 [Last accessed on 2013 Nov 25].
  CrossrefPubMedGoogle Scholar
• 9 Klein WoolthuisEP, De Grauw WJ, van Gerwen WH, van den Hoogen HJ, van de Lisdonk EH, Metsemakers JF. et al. Yield of opportunistic targeted screening for type 2 diabetes in primary care: The diabscreen study. Ann Fam Med [Internet] 2009; 7: 422-430 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2746521&tool=pmcentrez&rendertype=abstract [Last accessed on 2013 Dec 3].
  CrossrefPubMedGoogle Scholar
• 10 Diabetes Atlas | International Diabetes Federation [Internet]. 2013 Available from: http://www.idf.org/diabetesatlas [Last accessed on 2013 Nov 22].
  PubMedGoogle Scholar
• 11 Operational guidelines. National programme for prevention and control of cancer, diabetes, cardiovascular disease and stroke (NPCDCS). Directorate General of Health Services, Ministry of Health & Family Welfare. Government of India. [Internet] 2011 Available from: y [Last accessed on 2013 Nov 22].
  PubMedGoogle Scholar
• 12 Bharati DR, Pal R, Kar S, Rekha R, Yamuna TV, Basu M. Prevalence and determinants of diabetes mellitus in Puducherry, South India. J Pharm Bioallied Sci [Internet] 2011; 3: 513-518 Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=22219584 [Last accessed on 2012 Jun 1].
  CrossrefPubMedGoogle Scholar
• 13 Gupta SK, Singh Z, Purty AJ, Kar M, Vedapriya D, Mahajan P. et al. Diabetes prevalence and its risk factors in rural area of Tamil Nadu. Indian J Community Med [Internet] 2010; 35: 396-399 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2963877&tool=pmcentrez&rendertype=abstract [Last accessed 2013 on Nov 22].
  CrossrefPubMedGoogle Scholar
• 14 Gupta SK, Singh Z, Purty AJ, Vishwanathan M. Diabetes prevalence and its risk factors in urban Pondicherry. Int J Diabetes Dev Ctries [Internet] 2009; 29: 166-169 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2839131&tool=pmcentrez&rendertype=abstract [Last accessed on 2013 Nov 22].
  CrossrefPubMedGoogle Scholar
• 15 Majgi SM, Soudarssane BM, Roy G, Das AK. Risk factors of diabetes mellitus in rural Puducherry. Online J Health Allied Sci [Internet] 2012; 11: 1-7 Available from: http://www.ojhas.org/issue41/2012-1-4.htm [Last accessed 2013 Nov 23].
  Google Scholar
• 16 Somannavar S, Ganesan A, Deepa M, Datta M, Mohan V. Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India. Diabetes Care [Internet] 2009; 32: 641-643 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2660445&tool=pmcentrez&rendertype=abstract [Last accessed on 2013 Nov 22].
  CrossrefPubMedGoogle Scholar
• 17 Screening for Type 2 Diabetes. Report of a World Health Organization and International Diabetes Federation meeting, 2003. [Internet]. Geneva: 2003. Available from: http://www.who.int/diabetes/publications/en/screening_mnc03.pdf [Last accessed on 2013 Nov 22].
  Google Scholar
• 18 Guidelines for Management of Type 2 Diabetes. Indian Council of Medical Research (ICMR). New Delhi, India: [Internet] 2005. Available from: http://icmr.nic.in/guidelines_diabetes/guide_diabetes.htm [Last accessed on 2013 Nov 22].
  Google Scholar
• 19 Waugh N, Scotland G, McNamee P, Gillett M, Brennan A, Goyder E. et al. Screening for type 2 diabetes: Literature review and economic modelling. Health Technol Assess 2007; 11: 1-125 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17462167 [Last accessed on 2013 Nov 25].
  CrossrefPubMedGoogle Scholar
• 20 Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J Assoc Physicians India [Internet] 2005; 53: 759-763 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16334618 [Last accessed on 2013 Nov 25].
  PubMedGoogle Scholar
• 21 Nazir A, Papita R, Anbalagan VP, Anjana RM, Deepa M, Mohan V. Prevalence of diabetes in Asian Indians based on glycated hemoglobin and fasting and 2-H post-load (75-g) plasma glucose (CURES-120). Diabetes Technol Ther [Internet] 2012; 14: 665-668 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22823754 [Last accessed on 2013 Nov 25].
  CrossrefPubMedGoogle Scholar
• 22 Shewade HD, Palanivel C. Preventive medicine clinics in hospitals of India: An opportunity missed. Int J Med Public Health 2013; 3: 2-4
  CrossrefGoogle Scholar