Screen ALL over 40s for diabetes

But critics warn new drive to spot illness earlier will just clog up busy GPs’ surgeries

‘Deflects resources from patients’

EVERYONE over 40 should be screened to test their chance of getting diabetes, the public health watchdog says today.

Up to four million people in England already have it, and officials believe a further five million are at high risk.

In new guidance, Nice is urging all over-40s to calculate their risk either through an online questionnaire or by visiting a GP, pharmacist, optician or dentist.

Anyone whose score is high will be offered further tests to measure their blood sugar level. Patients whose level is very high will be sent on a 13-step intensive behavioural change course where they will be told to lose weight, avoid red meat and start exercising.

Nice wants at least 1.7million adults who are at the highest risk of developing diabetes to be referred on to the intensive courses by their family doctors.

But GP leaders last night warned that ‘blanket checks’ for all over40s could lead to patients having unnecessary tests, taking up precious appointment time.

Diabetes costs the NHS almost £9billion a year and one in six hospital beds at any one time are occupied by someone with the condition. The number of patients diagnosed has increased by 60 per cent in a decade due to rising levels of obesity, which greatly increases the risk.

The illness can be prevented and even reversed – after patients have been diagnosed – through basic lifestyle changes which lower the blood sugar.

As a first step, Nice is encouraging all over-40s to get themselves screened. Anyone who is from an ethnic minority and aged 25 to 39 should also be screened as they are at higher risk of type 2 diabetes. The online assess- ment, called the Know Your Risk form, is available on the Diabetes UK website and asks patients their age, weight, height, waist circumference and family history. They are given a score and told if their risk of diabetes is high, moderate, slightly increased or low.

GPs are being told to identify if patients are at risk of diabetes as part of their NHS Health Check, which is offered to those aged 40 to 74 every five years. And dentists and opticians are being urged to assess patients’ diabetes risk during routine check-ups.

Dr Mark Baker, director of the centre for guidelines at Nice, said the aim was to identify adults who had no idea they were at risk of diabetes. ‘We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes, and that this approach is a cost-effective way of managing an illness that currently costs the NHS around £8.8billion a year,’ he said.

‘We need to make sure that the people most at risk have access to the care they need.’

Dan Howarth, head of care at the charity Diabetes UK, added: ‘Type 2 diabetes is a serious condition that can lead to harrowing complications, so preventing it from developing in those at higher risk is hugely important.

‘ We welcome these updated guidelines, which recognise the importance of preventing the condition, and the serious harm it causes to those living with it.’

The behavioural change courses last at least nine months and patients have at least 13 one-toone sessions with nutritionists and fitness advisers. They are encouraged to do at least 150 minutes of exercise a week, slim down to a healthy body mass index, and avoid red meat and cakes.

But Professor Helen StokesLampard, of the Royal College of GPs, said: ‘We would advise caution in methods for targeting patients – blanket checks for all over 40s, for example, have the potential to subject healthy people to unnecessary tests, and this both deflects resources away from delivering patient care to those who really need it and could cause unintended harms. Any new national screening programme would need formal evaluation by the relevant bodies.’

Diabetes occurs when the blood sugar becomes very high, either because patients do not produce enough of the hormone insulin or their cells don’t respond. The raised blood sugar then damages the nerves and organs causing blindness, kidney damage, heart attacks and strokes.

Nice’s role includes issuing public health guidelines as well as deciding which medicines are cost- effective and can be prescribed on the NHS. But some of the watchdog’s previous advice has been criticised as patronising and overly nannying. This includes recommendations on driving more smoothly to reduce exhaust fumes, keeping a food diary to lose weight and not spending more than ten minutes in the sun.

Eating too much salt significantly raises the risk of diabetes, researchers have found. For every extra 2.5g we consume each day – roughly the amount found in a single rasher of bacon – the risk increases by 65 per cent, according to the study of 2,800 people from the Karolinska Institute in Sweden.