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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

8.4 Type 2 diabetes

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 and Torres Strait Islander peoples

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

Abnormal blood glucose is a modifiable risk factor for CVD and a diagnosis of diabetes substantially increases a person’s absolute CVD risk score. The Australian type 2 diabetes risk assesment tool (AUSDRISK) is useful in assessing risk of diabetes. Preventive interventions (refer to Table 8.4.3) have been shown to reduce progression to diabetes in patients with impaired fasting glucose.

Patients at high risk should be screened for diabetes every three years from 40 years of age. Aboriginal and Torres Strait Islander peoples should have their risk of diabetes assessed every three years from 18 years of age. Screening should be part of a comprehensive CVD assessment including BP, lipids, smoking, physical activity, diet, overweight and obesity.

Table 8.4.1. Type 2 diabetes: Identifying risk
Who is at risk?What should be done?How often?
Increased risk
  • ≥40 years of age
  • Aboriginal and Torres Strait Islander peoples aged ≥18 years
AUSDRISK* (III, B)56 Every three years (III, C)
High risk
  • ≥40 years of age and being overweight or obese (refer to Section 7.2. Overweight)
  • AUSDRISK score of 12 or more
  • Consider screening the following groups because they may be at increased risk for diabetes at an earlier age or lower body mass index (BMI):
    • first-degree relative with diabetes
    • high-risk race/ethnicity (Indian subcontinent or Pacific Islanders)
    • all people with a history of a previous cardiovascular event (eg acute myocardial infarction or stroke)
    • women with a history of gestational diabetes mellitus
    • women with polycystic ovary syndrome
    • patients on antipsychotic drugs
Fasting blood glucose (III, B) 57–59

OR

glycated haemoglobin (HbA1c)
Every three years (III, C)
  • Those with impaired glucose tolerance test or impaired fasting glucose (not limited by age)
Fasting blood glucose (III, B) or HbA1c58 Every 12 months (III, C)
*The Australian type 2 diabetes risk assessment tool (AUSDRISK)

BMI, body mass index; HbA1c, glycated haemoglobin
Table 8.4.2. Tests to detect diabetes*
TestTechnique
Fasting blood glucose Measure plasma glucose levels on a fasting sample: 58
  • <5.5 mmol/l: Diabetes unlikely
  • 5.5–6.9 mmol/L: May need to perform an oral glucose tolerance test
  • ≥7.0 mmol/L (>11.1 non-fasting): Diabetes likely; repeat fasting blood sugar on a separate day to confirm
The test should be performed on venous blood and tested in a laboratory to confirm a diagnosis

Impaired fasting glucose is diagnosed on the basis of a result between 6.1 and 6.9 mmol/L
Glycated haemoglobin (HbA1c) HbA1c may be used as a diagnostic test for diabetes. HbA1c of ≥48 mmol/mol (6.5%) is diagnostic of diabetes 60, 61
Oral glucose tolerance test Measure the plasma glucose before (fasting) and two hours after a 75 g glucose load is taken orally. Diabetes is diagnosed if fasting plasma glucose is ≥7.0 mmol/L or two-hour plasma glucose is ≥11.1 mmol/L. If the two-hour plasma glucose is between 7.8 and 11.0 mmol/L, there is impaired glucose tolerance. A two-hour result <7.8 mmol/L is considered normal 58
*Cut off levels for classifications vary by national and World Health Organization (WHO) guidelines, and are subject to change as more evidence is developed

HbA1c, glycated haemoglobin; WHO, World Health Organization
Table 8.4.3. Type 2 diabetes: Preventive interventions
Target groupIntervention
Impaired glucose tolerance, impaired fasting glucose and those with an elevated Australian type 2 diabetes risk assesment tool (AUSDRISK) score or with other specific high-risk factors
  • Increasing physical activity (eg 30 minutes brisk walking five times a week) and/or weight loss reduces risk of developing diabetes by 40–60% in those at high risk 62–65
  • Give advice on healthy low-fat diet (<30% kcal or kilojoules from fat and <10% from saturated fat; high fibre, low glycaemic index with cereals, legumes, vegetables and fruits), weight loss and increased physical activity (refer to Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice, 2nd edn)
  • Refer patients to a dietitian and a physical activity program
  • Provide pre-conception advice to women with a history of gestational diabetes
AUSDRISK, Australian type 2 diabetes risk assessment tool

The RACGP and Diabetes Australia’s publication General practice management of type 2 diabetes – 2016–18 provides guidance for the management of patients diagnosed with T2D.

References

  1. National Health and Medical Research Council. National evidence based guidelines for case detection and diagnosis of type 2 diabetes. Canberra: NHMRC, 2009.
  2. Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003;63:1468–74.
  3. Colagiuri S, Davies D, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Canberra: Diabetes Australia and the National Health and Medical Research Council, 2009.
  4. Siu AL. Screening for abnormal blood glucose and type 2 diabetes mellitus: US Preventive Services Task Force recommendation statement. Ann Intern Med 2015;163(11):861–68.
  5. d’Emden MC, Shaw JE, Jones GR, Cheung NW. Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus. Med J Aust 2015;203(2):89–90.
  6. World Health Organization. Report of a World Health Organization Consultation – Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Diabetes Res Clin Pract 2011;93:299–309.
  7. Knowler WC, Barrett-Connor E, Fowler S, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Eng J Med 2002;346:393–403.
  8. Pan X, Li G, Hu Y, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerence: The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537–44.
  9. Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of type 2 diabetes melllitus by changes in lifestyle among subjects with impaired glucose tolerance. N Eng J Med 2001;344:1343–50.
  10. Williamson DF, Vinicor F, Bowman BA. Primary prevention of type 2 diabetes mellitus by lifestyle intervention: Implications for health policy. Ann Intern Med 2004;140(11):951–57.
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