GPs should go through their practice records and identify all patients aged over 25 who are at high risk of type 2 diabetes – in particular those of South Asian descent – a new draft NICE guideline recommends.
The guideline – put out for consultation today – marks a massive expansion in diabetes screening, with NICE recommending GPs invite all patients identified as high risk for a blood test.
It says GPs should use a validated risk-assessment tool to assess data in practice records and that people aged 75 and over and those aged between 25 and 39 from a South Asian background in particular should also be encouraged to have a risk assessment. But the guideline was unclear about how actively GPs should follow up patients.
The guidance says: ‘GPs or other primary care health professionals should use a validated risk-assessment tool (such as the Cambridge risk score which uses routinely collected practice data) to identify all adults aged 25 and over on their GP practice register who may be at high risk of type 2 diabetes.’
If the practice risk score cannot be used, then the guidance recommends giving all non-pregnant adults in the practice aged over 25 years a self-assessment questionnaire.
The guidance says: ‘Trained healthcare professionals should carry out blood tests for adults with high risk scores. They should also test all those aged 25 and over of South Asian or Chinese descent whose BMI is greater than 23 kg/m2.’
The guideline provides evidence for the expansion of the Department of Health’s flagship NHS Health Checks scheme to include younger South Asian patients, but a spokesperson said that the guidance was for all GP practices, and not just those carrying out vascular checks.
A NICE spokesperson said: ‘The practice risk score uses routinely collected data that is included in all medical records. This is very little work – though it helps if records are up to date. If it shows that patients are at high risk, then they can invite them for a blood test.’
Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE, said: ‘This guidance will help identify potentially thousands of people who, because of their lifestyle, diet, lack of physical activity or obesity, are at risk of developing type 2 diabetes, and sets out evidence-based interventions that are effective at reducing that risk.’
Dr Bill Beeby chair of the GPC´s clinical and prescribing subcommittee said: ‘I thought GPs already used their common sense in the surgery. Where’s the evidence that screening everybody is worth it rather than assessing patients in the normal way?’
‘This may sound like a great idea in theory, but with commissioning and the QIPP agenda driving work out of hospitals and into primary care, GPs just haven’t got time to take it on.’
On the proposal to screen all over-25s he said: ‘If that´s what´s proposed, it will fall at the first fence. The consultation on this will involve a lot of practicalities. The GPC will be taking soundings and responding appropriately.’
Consultation on the draft NICE guidance closes on 9 January 2012. Click here to read the full guideline.
Story updated 10:40