Screening and identifying diabetes in optometric practice: a prospective study

Abstract

BackgroundUnconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. AimThe study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Design and settingAdults attending high street optometry practices in northern England who selfreported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. ResultsOf 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. ConclusionScreening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings. Keywordsdiabetes mellitus, type 2; optometry; prediabetes; primary care; screening.e436 British Journal of General Practice, July 2011Screening and identifying diabetes in optometric practice: a prospective study Britain (RPSGB). 17 In the US, it has been determined that 60% of adults visit dentists at least once a year for routine care, and so this may be a suitable location to screen for diabetes. 18Likewise, optometrists (opticians) are providers of routine, non-emergency care and may be accessed by those who are not receiving medical care. The age of onset of presbyopia and the subsequent deterioration in near vision coincides with the age that screening for diabetes is recommended by both Diabetes UK and the American Diabetes Association (ADA). This again may provide opportunities for optometrists to provide tests to those who may not access other healthcare services, particularly if they have no other medical problems.Optometrists provide eye health care worldwide and have the potential to provide services in both developed and developing countries. In the UK, 17 million sight tests are performed yearly, over one-third on people aged 60 years or over. 19 Optometrists are in a position to ask patients about diabetes risk factors during the course of a sight test. In Australia, it has been shown that around 80% of optometrists always or often ask patients aged over 40 years about diabetes. 20 Optometrists may be in a good position to reach a section of the population that may no...

Screening for diabetes in unconventional locations: Resource implications and economics of screening in optometry practices

“…None of these risk factors require the participants to have previously attended a GP. Though people may misreport their weight and height [20,21], resulting in underreporting of obesity levels, over 40% of participants in our study reported that they had a BMI of 25kg/m 2 or more, suggesting that people are willing to report this as a risk factor [11]. Only screening those aged 40 years or more with either a family history of diabetes or self reported BMI of 25kg/m 2 or more would have halved the number of tests carried out, and identified around two thirds of those who were diagnosed with hyperglycaemia following participation in the study.…”

“…14 Logistic regression showed the BMI of 25kg/m 2 or more, family history of diabetes and increased age increased the likelihood of having a rCBG of 6.1mmol/l or more [11]. None of these risk factors require the participants to have previously attended a GP.…”

“…Participants were sent a postal questionnaire four to six weeks after the screening test to determine whether they had seen their GP, whether any tests had been carried out and if any diagnosis had been given. Full results of screening are detailed elsewhere [11].…”

“…A logistic regression analysis of the risk factors used in this screening programme showed that age, family history and BMI increased the likelihood of having a rCBG measurement of 6.1mmol/l or more, while female gender reduced the likelihood of referral for further investigations [11]. If we chose a strategy of screening only those aged 40 and over with either a family history of diabetes, a BMI of 25kg/m 2 or both, we would have tested 507 of the participants, of which 193 (38.1%) would require further investigation.…”

“…It has the benefit that, as fasting is not required, it can be used opportunistically. A pilot study was implemented in optometry (opticians) practices to determine the feasibility of carrying out rCBG screening in this location [11]. 4 To determine the resource implications and cost effectiveness of using rCBG tests to detect raised blood glucose levels in "at risk" population attending optometry practices.…”