Diabetic patients detected by population-based stepwise screening already have a diabetic cardiovascular risk profile

Abstract

OBJECTIVE - To describe a population-based two-step screening procedure for type 2 diabetes and to study the cardiovascular risk profile of the patients identified by the screening. RESEARCH DESIGN AND METHODS - The first step of the screening procedure consisted of the Symptom Risk Questionnaire (SRQ), and the second step was a fasting capillary glucose measurement. In subjects with an SRQ score of >6 and a capillary glucose level of >5.5 mmol/l, an oral glucose tolerance test was performed. RESULTS - A total of 11,679 inhabitants of the West-Friesland region of the Netherlands, aged 50-75 years, were invited. Of the inhabitants, 9,169 (78%) responded, and, of those, 417 had previously diagnosed diabetes. The SRQ score was calculated for 7,736 participants, and 3,301 of those had a score of >6. A total of 2,885 subjects (87.3%) attended for capillary glucose measurement. Diagnostic testing was carried out in 509 participants, and we identified 217 diabetic patients. In these patients detected by screening, mean HbA1c was 6.7% (±1.4). Hypertension and high total cholesterol levels (>5.0 mmol/l) were present in 70%, 33% had high triglyceride (>3.0 mmol/l) or low HDL cholesterol levels (<1.0 mmol/l in men and <1.1 mmol/l in women), and 40% were obese (BMI ≥30 kg/m2). CONCLUSIONS - The high response rate was the main feature of the screening by means of the Symptom Risk Questionnaire and fasting capillary glucose measurement followed by diagnostic testing. The 217 diabetic patients detected by the screening were characterized by relatively low HbA 1c levels and by a cardiovascular risk profile typical of diabetic patients.