Diabetes screening tool under scrutiny
Developer of questionnaire says agency not using it as designed to find people at risk of the disease
OTTAWA— The Public Health Agency of Canada developed an innovative screening tool meant to better identify people at risk of developing diabetes, but the former official in charge of the program worries it is not being used properly.
Chris Robinson, who left the public health agency following governmentwide job cuts last year, led the development of the Canadian Diabetes Risk Assessment Questionnaire (CANRISK), which forms part of the federal approach to dealing with the chronic disease afflicting nearly 2.4 million Canadians.
The Canadian version of the risk assessment tool originally invented in Finland is meant to give doctors a better idea of who may have undiagnosed type-2 diabetes and who may be able to stave off the disease through better nutrition and exercise, by asking people a series of questions about their age, weight, height, physical activity, family history and ethnicity.
The hope is that this tool will not only boost prevention efforts and find people with diabetes who are not currently experiencing any symptoms of the disease, but also save money by reducing the number of low-risk patients undergoing unnecessary blood tests.
The public health agency says it cost $1 million and has been translated into 11 other languages besides English and French, a key to reaching ethnic communities that are considered at higher risk of developing type-2 diabetes.
The auditor general highlighted the screening tool as one of the few positive things in a report released last week that otherwise chastised the public health agency for not tracking the $18 million it receives annually for diabetes-related activities.
Robinson contacted the Star following the release of the report because he believes the auditor general missed what he argues is a big problem with the way the public health agency rolled out CANRISK.
In November 2011, the Conservative government announced it would be making it available at private pharmacies and online, but Robinson said it was originally intended to be integrated into the primary health-care system, where doctors would be able to follow up by referring patients for blood tests or lifestyle education if the results indicated a moderate to high risk.
“Within a pharmacy setting, CANRISK only serves to raise awareness about diabetes risks in a general way,” Robinson said.
Kim Elmslie, director general at the Centre for Chronic Disease Prevention at the public health agency, defended the approach, saying it is a way to reach more people.
Elmslie also noted pharmacies are only the beginning.
“As with any tool like this, it takes time for it to be tested in different sites and settings and to be taken on board,” Elmslie said.
The three-year chronic disease strategic plan the Conservative government published last month notes both New Brunswick and Alberta are exploring options for integrating the questionnaire into their screening programs and that widespread adoption of CANRISK remains a desired outcome.
The Canadian Diabetes Association also included use of the tool as a way to screen for type-2 diabetes in the latest version of its clinical practice guidelines released last month.
The new guidelines recommend doctors perform a blood test every three years for patients aged 40 and up, or those who score high using a risk calculator such as the tool developed by the federal government, instead of using age as the sole criterion.
Dr. Ron Goldenberg, an endocrinologist and diabetes expert, said this may do more to raise awareness of the screening questionnaire than government efforts would.