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The Scottish Health Survey: Detecting undiagnosed diabetes and pre-diabetes Catherine Bromley, ScotCen; Sarah Wild, University of Edinburgh; Helen Colhoun,

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Presentation on theme: "The Scottish Health Survey: Detecting undiagnosed diabetes and pre-diabetes Catherine Bromley, ScotCen; Sarah Wild, University of Edinburgh; Helen Colhoun,"— Presentation transcript:

1 The Scottish Health Survey: Detecting undiagnosed diabetes and pre-diabetes Catherine Bromley, ScotCen; Sarah Wild, University of Edinburgh; Helen Colhoun, University of Dundee Faculty of Public Health Conference Aviemore 10 November 2011

2 Research questions What is the prevalence of undiagnosed diabetes in adults in Scotland? What is the prevalence of people at increased risk of diabetes (pre-diabetes)? Can risk factors be used to target screening in primary care?

3 Data and definitions Data source 2008, 2009 and 2010 Scottish Health Survey Cross-sectional general population survey conducted in people’s homes Face to face interview followed by a nurse visit (16+) Measurements: BMI, waist circumference, blood pressure, venous blood samples Response to main interview each year: 54%, 56%, 55% Response to blood sample each year: 25% yr olds under-represented; men 55+, women over- represented Weighting used to adjust sample profile to match household population and to correct for non-response bias

4 Data and definitions Definitions Blood samples were tested for glycated haemoglobin (HbA1c) [analysers calibrated using DCCT standards] HbA1c captures average blood glucose concentration in preceding 3 months Pre-diabetes: HbA1c level >6% - <6.5% Undiagnosed diabetes: HbA1c level >6.5% Thresholds set by an International Expert Committee ,341 people aged 16+ years provided blood samples and did not have doctor-diagnosed diabetes (self-reported) Of whom, 1,727 were aged 40+ years

5 Risk factors explored here Age 40 years and over; 50 years and over BMI Overweight (BMI 25kg/m 2 - <30kg/m 2 ); obese (30kg/m 2 +) Waist circumference 100 -<110cm, 110cm+ Blood pressure Taking medicine for high BP or told by a doctor that BP is high Diabetes UK risk score Moderate risk; high risk

6 Diabetes UK risk score Derivation (points allocated per risk factor) Age – 49 years and under (0), (5), (9), 70+ (13) Sex – male (1), female (0) Ethnicity – white European (0), any other group (6) BMI – under 25kg/m 2 (0), 25 -<30 (3), 30 -<35 (5), 35+ (8) Waist circumference – under 90cm (0), 90 -<100cm (4), <110cm (6), 110cm+ (9) Hypertension – taking medicine for high BP or told by a doctor that BP is high (5) Family history – father/mother/sibling with DI or DM (5) Score range 0-47: 0-6=low risk, 7-15=increased risk, =moderate risk, 25+=high risk

7 Diabetes UK risk score – SHeS data Derivation (points allocated per risk factor) Age – 49 years and under (0), (5), (9), 70+ (13) Sex – male (1), female (0) Ethnicity – white European (0), any other group (6) BMI – under 25kg/m 2 (0), 25 -<30 (3), 30 -<35 (5), 35+ (8) Waist circumference – under 90cm (0), 90 -<100cm (4), <110cm (6), 110cm+ (9) Hypertension – taking medicine for high BP or told by a doctor that BP is high (5) Family history – father/mother/sibling with DI or DM (5) Score range 0-42: 0-6=low risk, 7-15=increased risk, =moderate risk, 25+=high risk

8 Diabetes prevalence

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10 Risk factors: age

11 Risk factors: BMI & age 40+

12 Risk factors: Waist circumf. & age 40+

13 Risk factors: Hypertension & age 40+

14 Risk factors: DUK risk tool & age 40+

15 Population burden & yield

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20 Screening yield potential

21 Key points Effective risk combinations age 40+ & BMI 25+: but applies to 44% of adults Age 40+ & BMI 30+: useful for undiagnosed diabetes, but only captures half as much pre-diabetes as 40+ & BMI & hypertensive: might be worth considering? Diabetes UK moderate or high risk score: useful for both measures, applies to 27% of adults - but requires time to do risk assessment Strengths: Large non-diabetic sample; objective measures Weaknesses: Non-response bias; missing data; small sample for undiagnosed diabetes analysis (n~50)


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