Are Your Patients at Risk? Diabetes Screening Update

Here's a scary statistic: Americans born in 2000 or later have a lifetime risk of more than one in three of developing type 2 diabetes.¹ The problem extends across the world, with increasing cases of diabetes in developed and developing nations like the U.K., China and the Arab Emirates.¹

Diabetes is a growing world public health concern for several reasons.^1-6 Long-term systemic consequences of type 2 diabetes can lead to retinopathy, nephropathy and neuropathy. On a larger scale, diabetic complications contribute vascular events such as stroke and myocardial infarctions.² In fact, an estimated 65-80 percent of people with diabetes will die of a cardiovascular event. Many of these will not show prior signs or symptoms of cardiovascular disease.² Diabetes also impacts quality of life in terms of malaise, fatigue, wound healing and sexual dysfunction.

Type 2 diabetes is a prevalent and costly chronic illness that demands lifestyle interventions, effective monitoring and sometimes pharmacologic management.³ The good news is that we have the power to control common risk factors including physical inactivity, blood pressure and blood lipid levels, as well as blood glucose levels.³

Calculating Risk

Over the past several years, many diabetes risk score models have been created.^3-6 These tools are easy-to-use questionnaires that increase awareness and help gauge risk of developing type 2 diabetes and/or requiring pharmacological intervention. The following is based mostly on the Finnish Diabetes Risk Score or FINDRISC. In essence, this questionnaire can be viewed as an indicator of metabolic syndrome, with two added questions specific to medical and family history.

Metabolic syndrome is not new. Many researchers, chiropractors and health advocates the world over are recognizing the association of metabolic syndrome to mortality and morbidity attributable to the world's biggest health threats. So much so that a review of the literature suggests that modifiable risk factors play a larger role than family history.^2-3 Two authors in my brief review suggested that although exercise is a valuable aspect of a healthy lifestyle waist circumference, BMI, high blood pressure and evidence of impaired glucose metabolism are more critical to evaluating risk.^4,6

The FINDRISC, among other risk score calculators, attempts to identify those that may require more aggressive blood sugar control. The higher the score, the higher the risk. In general, low scores are better. Like all tools, they do not provide the right answer for all people all the time. These tools evaluate risk and help answer the question, "Should I seek further guidance from a health care professional?"

One study suggests that those with high and very high risk should be the first in line. This does not mean they will require pharmacological intervention; it does mean lifestyle changes must be made and should not be put on the back burner.^2-3

Furthermore, the research suggests these tools help guide health care professionals in prioritizing further testing for type 2 diabetes. Thirty percent to 60 percent of people with diabetes go undiagnosed, which can have potentially life-limiting consequences. On the flip side, overtesting leads to overdiagnosing, false positives and unintentionally creates problems that could have been avoided. This is a sticky point and it is still unclear who should or should not be tested, but the health care community is moving in the right direction by focusing on high-risk individuals and using their judgment in questionable cases.^3-6

Take-Home Point

Type 2 diabetes is preventable.^3-6 Pharmacological intervention is not always necessary early on, provided people can control their risk factors. I still haven't met anyone who wants to live on meds. Many studies show that lifestyle plays a critical role in developing disease, even in people with a strong family history. So, don't think you are doomed if diabetes runs in the family.

That said, nothing is new under the sun. We live in a gluttonous society. Counsel patients to eat right, exercise, maintain a healthy weight, stop smoking, drink in moderation, etc. More important, lead by example. You have heard it all before, but now you have a tool to prioritize your patients and concentrate efforts.

So, for all you wellness advocates, Paleo-promoters, supplement sellers and cross-fitters, keep fighting the good fight! Stay healthy. Live better. Pass it on.

References

1. Noble D, Mathur R, Dent T, Meads C, Greenhalgh T. Risk models and scores for type 2 diabetes: systematic review. BMJ, 2012;343:d7163.
2. Canadian Task Force on Preventive Health Care. Recommendations on screening for type 2 diabetes in adults CMAJ, Oct. 16, 2012;184:1687-1696.
3. "Type 2 Diabetes Screening Guidelines Updated." Medscape, Oct. 18, 2012.
4. Saaristo T, Peltonen M, Lindström J, Saarikoski L, Sundvall J, Eriksson JG, Tuomilehto J. 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, May 2005;2:67-72.
5. Lindstrom J, Tuomilehto J. The Diabetes Risk Score: a practical tool to predict type 2 diabetes risk. Diab Care, March 2003;26:725-731.
6. Santos RD, et al. The Diabetes Risk Score as a marker of coronary disease risk, metabolic syndrome subclinical inflammation and hepatic steatosis. http://spo.escardio.org/eslides/view.aspx?eevtid=40&fp=P5480

For a copy of the questionnaire, search FINDRISC or Finnish Diabetes Risk Score.