Impact of a national diabetes risk assessment and screening programme in England: a quasi-experimental study. (November 2017)

• Record Type: Journal Article
• Authors: Palladino, Raffaele; Vamos, Eszter; Chang, Kiara C M; Millett, Christopher
• Is Part Of: Lancet. Volume 390(2017)Supplement 3
• Page Start: S65
• Publication Date: 2017-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(17)33000-3
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: The global prevalence of type 2 diabetes is increasing but the effectiveness of large-scale screening programmes to detect high-risk individuals (eg, those with non-diabetic hyperglycaemia) is debated. We assessed the impact of a national diabetes risk assessment and screening programme, NHS Health Checks, on detection of incident cases of non-diabetic hyperglycaemia and type 2 diabetes and on management of cardiovascular risk factors in newly diagnosed cases. Methods: In a quasi-experimental propensity score adjusted study, we extracted data on 370 454 individuals aged 40–74 years registered with 455 general practices in England between 2009 and 2016 without pre-existing type 2 diabetes. Individuals were characterised into three groups on the basis of their general practice's programme coverage (low, medium, high). We assessed differences in diagnosis of non-diabetic hyperglycaemia and type 2 diabetes and changes in cardiovascular risk (QRISK2 algorithm) using multilevel Cox and linear regression models. Propensity score, based on the probability of individuals being registered with a low, medium, or high coverage practice, was calculated. Analyses were by intention to screen. Findings: There were 138 364, 131 679, and 100 411 individuals in the low, medium, and high coverage groups, respectively. The incidence rate of detected non-diabetic hyperglycaemia was 19% higher in the high coverage group than in the low coverage group (2781 vs 2479 cases; hazard ratio 1·19, 95% CI 1·01 to 1·41), and rates of type 2 diabetes diagnosis (4058, 4657, and 3827 cases in low, medium, and high coverage groups) were 10% higher in the medium coverage group (1·10, 1·03 to 1·18) and 11% higher in the high coverage group (1·11, 1·03 to 1·19). Individuals with detected non-diabetic hyperglycaemia in the high coverage group had a 1·1% larger reduction in cardiovascular risk than did those in the low coverage group (β=–1·12, 95% CI −1·61 to −0·63; mean follow-up 43·9 months), and those with detected type 2 diabetes a 0·4% larger reduction (−0·42, −0·78 to −0·06; 49·8 months). Interpretation: Although only routinely collected information was used in this study, a robust methodology with a representative sample of the English population allows causal inference. General practices actively participating in a national diabetes screening programme had higher detection of non-diabetic hyperglycaemia and type 2 diabetes and, when newly detected, reduced cardiovascular risk. Funding: Part funded by the National Institute for Health Research (NIHR) under the Collaboration for Leadership in Applied Health Research and Care programme Northwest London.