The use of glucose measurements to improve screening for diabetes in clinical practice

Abstract

Introduction: It is estimated that 4 million people will be living with diabetes in England by 2025. It is imperative that we can accurately identify people at risk of diabetes and target interventions to prevent its development. Aim: To determine whether the addition of glucose measurements to the Leicester Risk Assessment Score (LRAS) improves the prediction of HbA1c ≥42mmol/mol (6.0%) compared with a risk score alone, and reduces the number requiring additional tests to determine their glycaemic status. Method: LRAS and HbA 1c were assessed in 484 participants (aged 40-80 years). 184 participants recruited directly from primary care underwent a fasting glucose measurement while 300 participants recruited through advertisement to the general public attended for a random capillary glucose. Results: A LRAS of ≥17 had a sensitivity of 79.6% and specificity of 60.1% to predict the HbA1c value of ≥42 mmol/mol (6.0%). The addition of a fasting glucose to the LRAS improved the explained variation in HbA1c from 20.8% with a risk score alone to 46.7%. In addition the number of people requiring further assessment of their glucose status was reduced from 43.8% to 33.2%. The addition of a random capillary glucose to the LRAS did not significantly improve the model. Conclusions: The addition of a fasting blood glucose, but not a random capillary glucose, to the LRAS improves the prediction of HbA1c ≥42mmol/mol (6.0%) and reduced the number of people who would need further diagnostic testing for diabetes.