Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in Western Nigeria: Implication for diabetes prevention

Abstract

Background: For many decades, hypertension guidelines recommended dual-arm blood pressure measurement. However, this practice is poor in Nigeria and its significance is largely unidentified. Hence, this study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus.Methods: A cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms.Results: One-hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents, respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents, respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8%, respectively. Significant systolic inter-arm difference (p = 0.033) and diastolic inter-arm difference (p = 0.01) were significantly more among respondents with hypertension and/or diabetes mellitus.Conclusion: The blood pressure readings in both arms were different among the majority of the respondents, being higher on the right arm in many of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.

Improving screening of prediabetes and undiagnosed diabetes

“…Because macrovascular and microvascular complications can start to develop with even mild hyperglycemia, clinicians should screen individuals as early as possible before DM symptoms occur. Several studies support the use of a diabetes risk tool as a reliable and valid tool to detect undiagnosed DM and PreDM with a sensitivity and specificity range of 77–83% and 65–72%, respectively (Franciosi et al, 2005; Heikes et al, 2008; Lindstrom & Tuomilehto, 2003; Ojo et al, 2020; World Health Organization, 2003). Woo et al (2017) completed a long-term cohort study that found the adoption of the ADA Diabetes Risk Test to be generalizable and straightforward with high specificity, positive predictive value, and positive likelihood ratio, allowing for fewer individuals needing more invasive testing.…”