Guideline calls for more precision and convenience in screening process
Ottawa, 16 October, 2012–The Canadian Task Force on Preventive Health Care (CTFPHC) today released an updated guideline calling for more precision in type 2 diabetes screening. The guideline, prepared by the independent panel of 14 clinicians and experts in research, prevention, and primary care in Canada, suggests using a risk calculator as a means of identifying patients who require routine screening with a blood test. The guideline is published in the Canadian Medical Association Journal.
The new guideline is based on the best and latest evidence, including a large randomized controlled trial published on 4 October, as well as the newest tools available in diabetes screening. The guideline is an update to the 2005 Canadian Task Force on Preventive Health Care Guideline. Aimed at physicians and policy makers, the guideline contains screening recommendations for type 2 diabetes in asymptomatic adults for low to moderate as well as high risk and very high risk of diabetes.
“Despite the progress we’ve made and continue to make in this area, diabetes continues to be a growing health concern in Canada,” said Kevin Pottie. “The updated guideline highlights the need to focus on those who are at high and very high risk, while addressing the need to further empower all patients to take an active role in managing and modifying their own risk factors.”
Currently, the general public considered ‘at risk’ of developing diabetes are screened annually, and sometimes unnecessarily, through blood tests. The new guideline does not recommend applying a blood test ‘en masse’, but instead recommends screening based on risk prediction level—with those at highest risk of developing diabetes being screened more frequently.
To identify risk prediction level, (i.e., low, moderate, high or very high) the CTFPHC recommends using either the FINDRISC or the CANRISK questionnaire—which enables initial risk calculation to take place in a range of different clinical and community settings, by a wide range of healthcare professionals. This means patients and their community health providers can play a larger role in identifying diabetes risk factors. It also means improving the efficiency of resource use by avoiding unnecessary blood testing.
“By introducing the risk questionnaire into the type 2 diabetes identification process, we are further engaging patients, along with a broader group of healthcare professionals in the prevention and detection of diabetes,” said the authors. “Not everyone requires a blood test, but we all have something ￼to gain from completing the questionnaire. By enhancing our understanding of risk factors we improve overall health outcomes.”
The new guidelines retain the benefits of those previous, but help improve the precision of screening. The main recommendations of the guideline include:
- The new guideline does not recommend applying a blood test to the general population, but instead recommends screening based on risk prediction level—it recommends that those at highest risk of developing diabetes be screened more frequently:
- For adults at low to moderate risk, the guidelines recommend not routinely screening for type 2 diabetes.
- For adults at high risk, the guidelines recommend routinely screening every 3–5 years. New evidence suggests screening more frequently does not lead to further improvements in patient outcomes.
- For adults at very high risk, the guideline recommends annual routine screening
- To identify risk prediction level (i.e., low, moderate, high or very high), the guidelines recommend using either the FINDRISC or the CANRISK questionnaire.
- After reviewing over 90 different variations of risk prediction models, FINDRISC and CANRISK were preferred by the Task Force.
- The FINDRISC and CANRISK questionnaires do not require a blood test, and their added precision in identifying risk may reduce unnecessary blood testing costs.
- By using either the FINDRISC or the CANRISK questionnaire, initial risk calculation can take place in a range of different clinical and community settings, by a wide range of healthcare professionals.
- Given the simplicity of risk calculation (i.e., use of FINDRISC and CANRISK), the potential exists to have patients calculate their own level of risk—which will lead to patients feeling more empowered and hopefully to taking action in modifying their own risk factors.
- For those requiring routine screening, the new guidelines recommend the use of non-fasting A1C as the preferred blood screening
For the complete report and details of the recommendations, please visit the Type 2 Diabetes Screening Guideline.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.