Preventive activities in general practice 7th edition

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Screening tests of unproven benefit

Appendices

Disclaimer

Type 2 diabetes

Type 2 diabetes age range table
Age	0 - 9	10 - 14	15 - 19	20 - 24	25 - 29	30 - 34	35 - 39	40 - 44	45 - 49	50 - 54	55 - 59	60 - 64	65 - 69	70 - 79	>80
								X	X	X	X	X	X	X	X
*			17	X	X	X	X	X	X	X	X	X	X	X	X

Type 2 diabetes age range table

Age

0 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 79

>80

* Aboriginal people and Torres Strait Islanders

Patients should be screened for diabetes every 3 years from 40 years of age using the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) (A). Aboriginal people or Torres Strait Islanders should be screened from 18 years of age. Those with a risk score of 15 or more should be tested by fasting plasma glucose (B).

Type 2 diabetes risk
Who is at higher risk of type 2 diabetes?	What should be done?	How often?	Level of evidence and references
Increased risk All patients >40 years of age Aboriginal people and Torres Strait Islanders	AUSDRISK (see Appendix 2)	Every 3 years	III B 321
High risk Any one of following risk factors: all people with a history of a previous CV event (acute myocardial infarction or stroke) women with a history of gestational diabetes mellitus (GDM) women with polycystic ovary syndrome those on antipsychotic drugs those with impaired glucose tolerance test (IGT) or impaired fasting glucose (IFG) (not limited by age)	Fasting plasma sugar	Every 3 years	III B 321,322

Type 2 diabetes risk

Who is at higher risk of type 2 diabetes?

What should be done?

How often?

Level of evidence and references

Increased risk

All patients >40 years of age
Aboriginal people and Torres Strait Islanders

AUSDRISK (see Appendix 2)

Every 3 years

III B 321

High risk

Any one of following risk factors:
- all people with a history of a previous CV event (acute myocardial infarction or stroke)
- women with a history of gestational diabetes mellitus (GDM)
- women with polycystic ovary syndrome
- those on antipsychotic drugs
- those with impaired glucose tolerance test (IGT) or impaired fasting glucose (IFG) (not limited by age)

Fasting plasma sugar

Every 3 years

III B 321,322

Type 2 diabetes intervention
Test	Technique	References
Fasting blood sugar	Measure plasma glucose levels preferably on a fasting sample, although a ‘random’ sample is acceptable for screening purposes. <5.5 mmol/L – diabetes unlikely 5.5–6.9 mmol/L fasting – may need to perform an oral glucose test 7.0 mmol/L or more fasting (>11.1 nonfasting) – diabetes likely, repeat fasting blood sugar to confirm on a separate day The test should be performed on venous blood and tested in a laboratory. However, capillary blood and a properly calibrated point of care device may be used for screening (if a laboratory is used to confirm a positive result)	321
Oral glucose tolerance test	Two hours after a 75 g oral glucose load is taken, the plasma glucose is measured. If this is >11.1 mmol/L, diabetes is likely. If it is between 7.8 and 11.0 mmol/L then there is impaired glucose tolerance. If it is <7.8 mmol/L diabetes is unlikely	321
Diabetes risk (AUSDRISK assessment tool)	Diabetes risk may be calculated using the AUSDRISK assessment tool. This calculates a score related to the risk of developing diabetes over a 5 year period based on cohort data for that population (see Appendix 2) (The tool may underestimate risk below the age of 25 years)	323
Glycosylated haemoglobin (HbA1c)	This is not currently recommended as a test to diagnose diabetes as the appropriate cut off is still to be determined	324 325

Type 2 diabetes intervention

Test

Technique

References

Fasting blood sugar

Measure plasma glucose levels preferably on a fasting sample, although a ‘random’ sample is acceptable for screening purposes.

<5.5 mmol/L – diabetes unlikely
5.5–6.9 mmol/L fasting – may need to perform an oral glucose test
7.0 mmol/L or more fasting (>11.1 nonfasting) – diabetes likely, repeat fasting blood sugar to confirm on a separate day

The test should be performed on venous blood and tested in a laboratory. However, capillary blood and a properly calibrated point of care device may be used for screening (if a laboratory is used to confirm a positive result)

321

Oral glucose tolerance test

Two hours after a 75 g oral glucose load is taken, the plasma glucose is measured. If this is >11.1 mmol/L, diabetes is likely. If it is between 7.8 and 11.0 mmol/L then there is impaired glucose tolerance. If it is <7.8 mmol/L diabetes is unlikely

321

Diabetes risk (AUSDRISK assessment tool)

Diabetes risk may be calculated using the AUSDRISK assessment tool. This calculates a score related to the risk of developing diabetes over a 5 year period based on cohort data for that population (see Appendix 2) (The tool may underestimate risk below the age of 25 years)

323

Glycosylated haemoglobin (HbA1c)

This is not currently recommended as a test to diagnose diabetes as the appropriate cut off is still to be determined

324
325

Prevention of diabetes

Prevention of diabetes
Target group	Intervention	References
Pre-diabetes (IGT, IFG, GDM) and those with identified risk factors with negative screening test	Increasing physical activity (eg. 30 minutes brisk walking 5 times per week) and/or weight loss reduces risk of developing diabetes by 40–60% in those at high risk³²⁶ Give advice on a healthy low fat diet (<30% kcal from fat and <10% from saturated fat). High fibre, low glycaemic index with cereals, legumes, vegetables, fruits, weight loss and increased physical activity (see SNAP guidelines) Refer patients to a dietician and a physical activity program Provide pre-conception advice to women with a history of gestational diabetes	327-329

Target group

Intervention

References

Pre-diabetes (IGT, IFG, GDM) and those with identified risk factors with negative screening test

Increasing physical activity (eg. 30 minutes brisk walking 5 times per week) and/or weight loss reduces risk of developing diabetes by 40–60% in those at high risk³²⁶
Give advice on a healthy low fat diet (<30% kcal from fat and <10% from saturated fat). High fibre, low glycaemic index with cereals, legumes, vegetables, fruits, weight loss and increased physical activity (see SNAP guidelines)
Refer patients to a dietician and a physical activity program
Provide pre-conception advice to women with a history of gestational diabetes

327-329

Guidelines for preventive activities in general practice 7th edition

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Type 2 diabetes

Prevention of diabetes