If screening for diabetes is such a good idea, asks David Stewart MP, then why hasn't it happened already?
The tabloids describe diabetes as britain's "silent killer". Officially 1.4 million people in the UK are diagnosed with diabetes but in addition several studies have confirmed that at least a million more - "the missing million" - are thought to have diabetes that is currently undiagnosed. There is also clear medical evidence of growth of diabetes across the UK and worldwide.
The effects of diabetes in both personal and financial terms are staggering. Diabetes is the main cause of blindness in those of working age and is the main factor in over half the lower limb amputations. The effect of diabetes on the individual can be devastating, particularly through other complications including heart disease, stroke and kidney disease. Diabetes accounts for up to 10 per cent of the NHS budget, which represents over £5 billion a year. Or, put another way, this is equivalent to £165 per second, nearly £10,000 a minute, and over £500,000 per hour.
The research makes depressing reading. People with diabetes are 15 times more likely to need amputation than people without the condition, and around 10 per cent of those receiving renal replacement therapy have diabetes.Is there a case for early identification of people with diabetes? I believe, along with Diabetes UK, that there is a strong case for high risk screening for Type 2 diabetes. Type 2, or non-insulin dependent diabetes, results where a relative deficiency or insensitivity to insulin increases the amount of glucose (sugar) in the blood because the body cannot use it properly.
Type 2 diabetes is more likely among those who are overweight, who have a family history of the condition, and who are over 40 years old. For example, the UK Prospective Diabetes Study showed that in 25-64 year olds newly diagnosed with Type 2 diabetes almost half had a close relative with diabetes. Additionally African-Caribbean or South Asian people are three to five times more likely to have diabetes than white members of the population. Clearly screening would have to be targeted. It is a waste of resources and unnecessarily alarming to individuals to have a large scale untargeted approach. What I am suggesting is highly specific targeting of those in the "at risk" category, involving a call and recall system through a local GP clinic, using a simple blood glucose test. Prevention is certainly better than cure but the evidence is worrying. The average Type 2 diabetic has had the condition between nine and 12 years before diagnosis. Because of that, over one third of people with Type 2 diabetes have at least one complication at the time they are diagnosed. Earlier treatment needs earlier detection. Late detection equals added complications, greater human misery and greater cost for the National Health Service.
If screening is such a good idea, why hasn't it happened already? Well, certainly there are many examples of a wealth of participants across the country where either individual GPs or health authorities have introduced some form of screening. However UK-wide screening requires a positive recommendation from the UK's National Screening Committee. They are not due to report back until 2005. In my view that is too late: we need clear national guidelines now. We need to detect the estimated one million people in the UK who currently suffer from diabetes but do not yet know it. We need to provide not just screening, of course, but emotional and educational support at an early stage following diagnosis. Diabetes is not just bad for your health; it is bad for your employment prospects as well.
Counselling and support are crucial at the early stage post-detection. The point is clear: to do nothing is not an option. Many diabetics lead a perfectly normal life if they are well managed, well controlled and they refuse to make a drama out of a crisis. I support the work of Diabetes UK and, like them, I argue that screening can bring benefits to those who have diabetes but who do not know they have it. Screening in my view is the best way to prevent the long-term human misery that is associated with the complications of diabetes.
Once Type II diabetes is diagnosed the priority is to enable the patient to effectively self-manage their condition so that it has a minimum impact on their ability to function normally in their day to day life.
Care must be tailored to the individual to suit their needs and abilities. Patients are encouraged to exercise regularly and give-up smoking. The primary strategy is generally to educate the patient to follow a prescribed diet and monitor their blood sugar levels at home - it is estimated that maintaining a tight control on blood glucose levels can lower the incidence of complications by up to 75 per cent.
The ideal glucose reading should be between four and seven mmol/l (millimoles/litre, the world standard unit for measuring glucose in blood barring the USA) before meals and less than 10 just after eating.
The regularity of testing varies from patient to patient, some preferring to test more frequently up to several times a day, two or three days a week - particularly during episodes of ill health or pregnancy, when four tests a day are recommended. Diabetes UK recommends testing just before meals, two hours after meals, and before bed, though it may be useful to occasionally test in the early hours of the morning to anticipate hypoglycaemic attacks during the night.
This can be done by testing the blood, urine or by using a wristwatch (such as the GlucoWatch Biographer) which has been specially developed to monitor blood glucose levels. The device works by the electrochemical analysis of fluid extracted from under the skin via a small disposable pad.
Blood testing is the most accurate method as urine testing can only indicate that the blood sugar level is high. And with the renal threshold often rising as patients get older, this means that some people will not produce a positive urine test until the blood glucose is 11 mmol/l or higher.The secondary goal is to monitor and prevent secondary complications such as diabetic retinopathy and kidney disease, with annual health checks. Blood pressure and cholesterol also both need regular checks to identify any hardening of the arteries.
