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Opportunistic GP screening for diabetes ‘cost-effective’

Practices could pick up many new cases of asymptomatic diabetes at minimal cost by opportunistically asking patients if they want a blood glucose test, conclude GP researchers.

The research – conducted by GPs at one practice in Devon – found two-thirds of patients picked up by opportunistic screening were asymptomatic, with a cost per case of under £400.

The study – published in Diabetes Medicine last month - raises questions about the large-scale diabetes prevention exercise recently recommended by NICE.

The institute recommended last month that GP practices systematically go through their lists and carry out a risk assessment in everyone aged 40 years or over without diabetes, and anyone aged 25 years or older in a high-risk group.

GPs at the St Leonard's Research Practice in Exeter asked all patients at high risk of diabetes attending a routine appointment if they would like a blood glucose test. Over three years, the practice recorded 86 patients with a new diagnosis of diabetes.

Of these, 54 (63%) were detected via opportunistic screening, giving a number needed to screen of 51.2. Two-thirds of these were found before any symptoms were reported and the average cost of the tests per case – taking into account laboratory, staff and administrative costs – was just £377.

Study leader Professor Denis Pereira Gray, a professor at the University of Exeter and a GP at St Leonard's Research Practice, said they had shown an opportunistic method was ‘very practical' and a cheaper alternative to NICE's approach.

Dr Gray said: ‘Of course, the pick-up level [for NICE's approach] will be much lower than in the St Leonard's study where high-risk patients were selected in the consulting room, and NICE's plan will raise the cost per case found well above the Exeter figure.'

He added: ‘We hope our research, which is very practical, will be of interest to colleagues in general practice and to policy makers.'

But Professor Roger Gadsby, a GP in Warwickshire and primary care lead for NHS Diabetes, said both the St Leonard's practice and NICE's methods were appropriate.

He said: ‘GPs should take opportunities to screen for diabetes when people attend for consultations for other reasons and the GP is aware that they may be at high risk.

‘However, some people at high risk of developing diabetes do not attend GP surgeries, so both opportunistic and an organised screening programme to which those at high risk are invited are needed. It is not one or the other, but both.'

A NICE spokesperson said it would take the new evidence into account when its guideline is revised.

He said: ‘All new evidence will be taken into consideration when we review the guidance in three years.'

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