General practice management of type 2 diabetes


Identifying risk of diabetes in asymptomatic patients
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☰ Table of contents


Recommendations


Reference

Grade*

Individuals should be screened for risk of diabetes every three years from 40 years of age using AUSDRISK

25
NHMRC, 2009

C

Individuals at high risk with any one of following risk factors:

  • AUSDRISK score of 12 or more
  • all people with a history of a previous cardiovascular event (acute myocardial infarction or stroke)
  • women with a history of gestational diabetes mellitus
  • women with polycystic ovary syndrome
  • patients on antipsychotic drugs

25
NHMRC, 2009

 

• should be screened with fasting blood glucose (or glycated haemoglobin [HbA1c])

 

B

• every three years

 

C

Individuals at high risk with impaired glucose tolerance test or fasting glucose (not limited by age) should be screened:

25
NHMRC, 2009

 

• with fasting blood glucose (or HbA1c)

 

B

• every 12 months

 

C

Risk assessment should begin from 18 years of age in Aboriginal and Torres Strait Islander peoples

25
NHMRC, 2009

Practice Point

*Refer to Summary, explanation and source of recommendations for an explanation of the level of evidence and grade of evidence


Clinical context


Type 2 diabetes is the most common form of diabetes in Australia, although many cases remain undiagnosed. Additionally, almost one in six adults is affected by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).1 Earlier detection increases opportunities to reduce morbidity and mortality.


In practice


Patients should be screened for diabetes risk every three years from 40 years of age using the Australian type 2 diabetes risk assessment tool (AUSDRISK; ). Aboriginal and Torres Strait Islander peoples should be screened from 18 years of age. Those with a risk score of 12 or more should have a blood examination for fasting blood glucose (FBG) or HbA1c.

Screen for undiagnosed diabetes in individuals at high risk 25,26 (Box 1).

Box 1. People considered to be at high risk of type 2 diabetes

  • People of any age with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)*
  • All patients with a history of a cardiovascular event (eg acute myocardial infarction, angina, peripheral vascular disease or stroke)
  • People aged ≥35 years originating from the Pacific Islands, Indian subcontinent or China
  • People aged ≥40 years with body mass index (BMI) ≥30 kg/m2 or hypertension
  • Women with a history of gestational diabetes mellitus (GDM)
  • Women with polycystic ovary syndrome (PCOS)
  • Patients taking antipsychotic medication

*Annual fasting blood glucose (FBG) or HbA1c is reserved for those people identified with IGT test or IFG (not limited by age)

 

 

Screening for risk of diabetes in specific or high-risk populations


There is a higher prevalence of type 2 diabetes in lower socioeconomic than higher socioeconomic Australians.27 Certain ethnic groups are more at risk.28 People with Pacific Islander, Southern European or Asian backgrounds are twice as likely as other Australians to have developed diabetes within five years.29

Aboriginal and Torres Strait Islander peoples are three times more likely to have diabetes than non-Indigenous Australians, and type 2 diabetes is a direct or indirect cause for 20% of Aboriginal and Torres Strait Islander peoples deaths.30

The AUSDRISK calculates the risk of developing diabetes over a five-year period. Patients with scores of 12 or more are considered at high risk (Table 1).
 

Table 1. Diabetes risk

AUSDRISK score

Risk of developing type 2 diabetes within five years*

≤5

1 in 100

 

6–8

1 in 50

 

9–11

1 in 30

12–15

1 in 14

16–19

1 in 7

≥20

1 in 3

*The overall score may overestimate the risk of diabetes in those aged <25 years and underestimate the risk in Aboriginal and Torres Strait Islander peoples

Practice points

  • For Aboriginal and Torres Strait Islander peoples, AUSDRISK can be used from 18 years of age.
  • Those considered at high risk (Box 1) should have an FBG or HbA1c test every three years.
  • People with low individual risk or who are from a community with low prevalence (<5%) may be screened for risk with AUSDRISK every three years.25

Refer to Chapter 13. Diabetes and reproductive health for recommendations on screening in pregnancy.


Diabetes Australian and RACGP logo's
 
  1. Shaw J, Tanamas S, editors. Diabetes: the silent pandemic and its impact on Australia. Melbourne: Baker IDI Heart and Diabetes Institute, 2012.
  2. Colagiuri S, Davies D, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Canberra: Diabetes Australia, NHMRC, 2009.
  3. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 8th edn. East Melbourne, Vic: RACGP, 2012; p 55–57.
  4. Australian Institute of Health and Welfare. Diabetes. AIHW; 2016.  [Accessed 16 February 2016].
  5. Whiting D, Unwin N, Roglic G. Diabetes: equity and social determinants. In: Blas E, Kurup AS, editors. Equity, social determinants and public health programmes. Geneva; WHO, 2010.
  6. Chen L, Magliano DJ, Balkau B, et al. AUSDRISK: An Australian Type 2 Diabetes Risk Assessment Tool based on demographic, lifestyle and simple anthropometric measures. Med J Aust 2010;192(4):197–202.
  7. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: AIHW, 2015.