Calls for UK to start screening for diabetes: Experts say cancer-like programme could spot hundreds of thousands of cases earlier
- Scientists examined records of Britons and found 1% had undiagnosed diabetes
- This equates to 250,000 people aged 40 to 70 unwittingly having condition
- The University of Exeter team called for middle-aged adults to be screened
The UK’s 25million middle-aged adults should be screened for type 2 diabetes, researchers said today.
Scientists, who examined the medical records of hundreds of thousands of Britons, found that one per cent had undiagnosed diabetes.
This equates to 250,000 people aged 40 to 70 across the UK unwittingly having type two diabetes, their study suggests.
However, they warned that the true toll will be much higher — as the medical database they consulted contains a disproportionate rate of healthy people.
The University of Exeter team called for middle-aged adults to be screened for the condition so those who have it can begin treatment earlier — similar to programmes already in place to detect bowel, breast or cervical cancer.
This scheme could slash the average time taken for a diabetes diagnoses by more than two years, according to the researchers.
Experts warn it is ‘dangerous’ to live with undiagnosed type two diabetes for too long due to the risk of ‘devastating complications’ including eye, kidney and nerve diseases.
The study is ‘by far the biggest’ of its kind – and the first to use real-world clinical data to analyse screening programmes of the general population in this way.
Scientists, who examined the medical records of hundreds of thousands of Britons, found that one per cent had undiagnosed diabetes. Pictured: Nurse giving a patient a diabetes test
Type 2 diabetes is a condition which causes a person’s blood sugar to get too high.
More than 4million people in the UK are thought to have some form of diabetes.
Type 2 diabetes is associated with being overweight and you may be more likely to get it if it’s in the family.
The condition means the body does not react properly to insulin – the hormone which controls absorption of sugar into the blood – and cannot properly regulate sugar glucose levels in the blood.
Excess fat in the liver increases the risk of developing type 2 diabetes as the buildup makes it harder to control glucose levels, and also makes the body more resistant to insulin.
Weight loss is the key to reducing liver fat and getting symptoms under control.
Symptoms include tiredness, feeling thirsty, and frequent urination.
It can lead to more serious problems with nerves, vision and the heart.
Treatment usually involves changing your diet and lifestyle, but more serious cases may require medication.
Source: NHS Choices; Diabetes.co.uk
It’s estimated that more like 850,000 adults are living with undiagnosed type two diabetes in the UK, according to Diabetes UK.
The study, which was published in Diabetologia, the journal of the European Association for the Study of Diabetes, identified people who had diabetes by looking at the results of those who had been given a HbA1c blood test.
People are considered to have type two diabetes if their HbA1c — which reflects a person’s blood sugar control — is 48 mmol/mol or higher.
The researchers, who analysed the data of 179,923 participants aged 40–70 years, found that among those who did not have a diagnosis of type two diabetes, around one per cent had undiagnosed diabetes.
Given there are around 25million adults of this age years living in the UK today without a diagnosis of diabetes, there are up to 250,000 undiagnosed cases that could be detected by simple HbA1c-based screening, the authors said.
By 10 years of follow-up, 12 per cent of undiagnosed cases had still either not received a clinical diagnosis or there was no data available on their outcome, according to the research.
The study showed that on average it took more than two years for those with undiagnosed diabetes to get a clinical diagnosis.
This means that having a regular HbA1c screening programme could reduce the time to diabetes diagnosis by more than two years.
Currently only adults who have a high risk of diabetes — calculated by a score — are offered a blood test by their GP.
However, as the study shows, these risk scores do not identify all patients with undiagnosed diabetes.
The study found that clinicians are more likely to screen men or individuals with obesity and less likely to screen women or individuals with a BMI below the obese range.
The authors said there is a need for increased awareness among healthcare professionals of the importance of type two diabetes checks in people without obesity
Professor Naveed Sattar, a diabetes expert at the University of Glasgow, said the study was an ‘advance’ in showing that further testing of HbA1c will pick up more people early in the course of diabetes diagnoses, as well as those ‘with a higher risk of diabetes, who could then undergo preventative efforts to slow them developing diabetes’.
He said it was ‘not impossible’ that a national screening programme — as is seen for things like bowel, breast or cervical cancer — could be introduced.
However he said there were lots of questions that needed to be answered before the effectiveness of what would be an expensive new programme could even be considered.
This would include decisions over aspects such as how often the tests should happen, whether everyone would be repeatedly tested — or only those at high risk, whether it is possible to send a test by post as with bowel cancer screening, or whether you need a nurse present to take blood, as is needed with a diabetes test, he said.
Prof Sattar said that ‘possibly’ when the NHS was not facing such a crisis could a national screening programme be introduced but for the moment he was ‘not convinced’ it would happen.
He said it first needed to be known what ‘the actual economic patient benefits’ were and whether they ‘outweigh the extra costs of testing the rest of the population’.
The study’s authors highlighted that, given healthcare spending in the UK is under intense pressure as economic circumstances worsen, ‘diabetes screening initiatives might be more important than ever to prevent long delays in diagnosis’.
They also said that unless diabetes risk scores are improved, population-based screening is ‘the only way to reliably identify undiagnosed diabetes’.
However, they echoed the sentiment that ‘the cost-effectiveness of this population-wide screening of older adults merits further assessment’.
Lead researcher of the study Dr Katie Young said: ‘I think it’s difficult because it is obviously dangerous for people to live with undiagnosed type two diabetes for a long period of time so it is important that we think about how we want to screen people and we should endeavour to pick people up earlier.
‘But it needs to be a balance with the cost effectiveness and channelling resources into this rather than something else.’
Lucy Chambers, Head of Research Communications at Diabetes UK, said: ‘This research provides clear evidence of delays in the diagnosis of type two diabetes and suggests that tests of average blood sugar levels at population level could help to pick up cases of type two diabetes sooner than they otherwise would be.
‘Early diagnosis is the best way to avoid the devastating complications of type two diabetes, and offers the best chance of living a long and healthy life with type two diabetes.
‘Type 2 diabetes can sometimes go undetected for up to 10 years, which can lead to serious complications.
‘13.6million people in the UK are at an increased risk of developing the condition, but many will be unaware of their risk.
‘While the symptoms of type 2 diabetes can sometimes be tricky to spot in the early stages, it’s important to know the signs to look out for, including being thirsty, unexplained weight loss, tiredness and passing urine more often.’
What health problems and diseases are already screened for by the NHS?
The NHS has a swathe of screening programmes aiming to catch health problems and disease early when they are easiest to treat.
With calls to make a specific diabetes screening programme MailOnline looks at those currently available:
NHS health screening technically begins before we’re even born.
Antenatal screening examines the health of a baby while they are in the womb.
It features a combination of ultrasounds and blood tests.
The blood tests can help determine if a baby has a chance of inherited conditions like sickle cell anaemia and if the mother has diseases like HIV hepatitis B or syphilis that medics need to be aware of.
An ultrasound can also help determine the general health of the foetus and if they have a condition like Down’s syndrome.
Shortly after a baby is born they undergo a variety of general health check.
This involves a physical examination of the baby, a hearing test and a blood test to detect any health conditions or disabilities.
The physical examination is generally done 72 hours after birth.
It examines the eyes, heart, hips and for boys the testicles for any developmental problems that need to be treated or monitored.
The blood test, which is taken from the baby’s heel, looks for nine rare but serious health conditions.
These include cystic fibroses, hormonal deficiencies and a variety of inheritable metabolic diseases.
A hearing test is conducted within the first few weeks to see parents will need additional support as their baby grows.
School entry health check
When children first enter school, between the ages of four and five, parents are offered a general check of their health.
This includes examines the height and weight of the child to check if the under or overweight.
Other checks involve hearing and vision tests to ensure children get the necessary treatment like hearing aids or glasses before they start learning.
Diabetes eye health check
This is a specific annual eye test that people with diabetes are invited for from the age of 12 onwards to ensure their disease is not damaging their vision.
It involves taking pictures of the back of the eye to find if the high blood pressure caused by diabetes is leading to loss of sight.
Called diabetic retinopathy, this damage can cause blindness if left untreated.
Cervical cancer screening
Women between the age of 25 and 64 are invited for a cervical screening check.
Commonly referred to as the smear test it involves taking a swab of cells from the cervix via a woman’s vagina and takes about 15 minutes.
This swab is sent for analysis for human papillomavirus (HPV) a group of viruses that can trigger changes to cells that lead to cancer.
If the sample tests positive further tests and monitoring may be required to ensure if cancer does occur, it is detected early.
The regularity of cervical screening depends on a woman’s age.
From 25 to 49 an invitation is sent every three years.
From 50 to 64 the check is done every five years.
Cervical screening usually ends at the age of 65 but is sometimes continued if HPV is detected in one of the final swabs.
The NHS 40+ health check
This is a broad check-up available for all adults in England from the age of 40 to 74.
It aims to spot a range of age-related health conditions like stroke, kidney disease, heart disease, type 2 diabetes, or dementia as early as possible.
The check involves a quiz from a medic on your general health and family history, a physical examination, as well as blood pressure and blood tests.
The whole process is designed to take about 20 to 30 minutes.
It is primarily designed for people who don’t have a pre-existing health condition, with those that do generally undergoing more regular tests.
People are generally invited once they hit their 40s, and then invited back for another check every five years thereafter.
Breast cancer screening
Women will be invited for a breast cancer screening to spot potential signs of breast cancer from the age of 50 onwards.
This check involves a mammogram, a special X-ray of the breast.
A total of four X-rays are taken, two for each breast in process that takes about half-an-hour.
Results are sent in the post with further tests required if any potential signs of cancer are spotted.
Women are invited back for screening every three years until the age of 71.
Bowel cancer screening
Both men and women are sent a home bowel cancer screening kit when they reach the age of 60.
This involves collecting a small sample of poo which is then sent to a lab to detect any traces of blood.
Blood in stool can be a sign of cancer or growths called polyps that can turn into cancer over time.
If the test detects anything potentially concerning the person is invited for further tests to ensure cancer is spotted early.
Like other cancers mentioned before, generally the earlier the disease is spotted the more effective potential treatment is.
After taking part in bowel cancer screening people are sent another kit every two years.
The programme is being expanded to include Britons aged 50 and over.
This expansion is gradual starting with people in their late 50s and commended in April 2021.
Abdominal aortic aneurysm (AAA) screening programme
The AAA programme is designed to detect for a bulge or swelling in the aorta which is the main blood vessel running from the heart to the abdomen.
If not detected early it can burst, causing life-threatening blood loss.
Screening for an AAA is offered to men over the age of 65 as they are the most likely group to suffer from the condition.
High blood pressure, high cholesterol, heart disease and being either a current or former smoker are risk factors for an AAA.
Screening for an AAA involves an ultrasound scan to check the physical condition of the heart.
People are generally told their results straight away.
Treatment depends on the size of the bulge.
Smaller ones are monitored regularly while a patient is recommended to make lifestyle changes like to their diet, exercise and cutting down on smoking and drinking.
Larger, more life-threatening AAAs may require surgery.
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