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Fasting blood glucose tests miss South Asian diabetes

GPs are likely to be missing large numbers of cases of diabetes in South Asian patients because tests fail to take into account ethnic differences, writes Eleanor Goodman.

Levels of fasting blood glucose that would be considered normal in white patients frequently indicate diabetes in South Asians, a study reveals.

The results suggest GPs need to be more willing to order glucose tolerance tests in South Asian patients in order to avoid missing a diagnosis.

Researchers found that conducting glucose tolerance tests on all white patients with a

fasting blood glucose above 6.1mmol/l detected diabetes with 100 per cent sensitivity.

But in South Asian patients, the threshold needed to be dropped to 5.6mmol/l to achieve the same sensitivity.

Dr Azhar Farooqi, an author of the study and a GP in Leicester, said South Asians with moderate fasting blood glucose were likely to be diabetic whereas white patients would not be.

'The main thing is you've got to be aware of this lower threshold – you can't just diagnose from fasting glucose. There'll

be workload issues there, because half of South Asians will require a glucose tolerance test.'

Dr Sagar Doshi, consultant cardiologist at Nuffield Hospital in Birmingham, said: 'We need to make our screening

programme more robust and standardise screening for diabetes in South Asians. The oral glucose test is the best test for detecting diabetes.'

But Farooqi said that it would not be possible to scrap the fasting glucose test. 'It's not feasible to do a two-hour test on the whole population. The fasting one is your entry port to deciding who needs a glucose tolerance test and who doesn't.'

The study used fasting blood glucose and glucose tolerance screening tests on 1,971 at-risk patients of South Asian and white European origin living in Leicestershire, who had been identified as having at least one risk factor for diabetes.

Risk factors included known coronary heart disease, hypertension, cerebrovascular or peripheral vascular disease and a family history of diabetes.

The results were presented at a South Asian Health Foundation conference on diabetes in London last week.

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GP care does not cut diabetes admissions

Improving care of diabetes in general practice does not have knock-on benefits for reducing hospital admissions, a new analysis reveals.

The results suggest the Government was wrong to assume practices with high rates of admissions were failing in their duty of care.

Researchers from Imperial College London analysed scores for diabetes in the quality and outcomes framework in 2004/5, during which practices averaged 93 per cent of the 99 available points.

Practices that achieved lower QOF points did not have higher admission rates than better-

performing practices, with correlations 'very weak' and not significant.

Study leader Dr Alex Bottle, lecturer in medical statistics in the department of primary care and social medicine at Imperial, said: 'Deprivation and prevalence seem more important influences on admissions than the quality of primary care. The results suggest improving primary care may not reduce demands on hospitals.'

Dr Brian Karet, diabetes lead for North Bradford PCT, said the results were counterintuitive. 'It's a bit contradictory. If you think about it, GPs with a specialism in diabetes will score highly in terms of QOF points and often refer less. But in some cases they may refer more. It

differs from area to area, so it's unsurprising that the variation cancels itself out overall.'

The research will be presented at the Diabetes UK annual conference in Glasgow next week.

Smoking success in diabetes patients

Paying GPs to provide smoking cessation advice has sharply

reduced smoking rates in patients with diabetes, new research has shown.

The proportion of patients with diabetes who smoked fell from 20 per cent before introduction of the contract in April 2006 to 16 per cent 18 months afterwards.

Over the same period, the proportion whose smoking status was recorded rose from 90 per cent in 2003 to 99 per cent in 2005. The proportion receiving advice leapt from 48 to 84 per cent.

Study leader Dr Christopher Millett, a specialist in public health at Imperial College London, said the introduction of the quality and outcomes framework had led to 'more systematic and equitable support for smokers'.

Dr Millett, who will present the research at the Diabetes UK annual conference in Glasgow next week, added: 'It's been

effective in reducing the prevalence of smoking.'

Dr Brian Karet, diabetes lead for North Bradford PCT, where he works as a GP, said practices had adapted 'fairly well' to giving smoking cessation advice – but not as well as in other areas.

'Education about the condition and the importance of weight management are things we are not doing so well. The intention was to include them as part of the national service framework that was supposed to have been introduced in January 2006 – so we're still running late on that one.'

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