A Call to Action for
Early Diagnosis in Diabetes:
Closing the gap between evidence, policy and practice
October 2015
AstraZeneca is committed to
Early Action in diabetes
AstraZeneca is approaching diabetes differently,
with fresh thinking and innovative, patient-centred
solutions that will redefine outcomes for people living
with the disease. Through our diverse portfolio of
medicines, collaboration with academia and the global
professional and advocacy communities, and our
early-stage research program, we are pushing the
boundaries of science with a focus on outcomes
beyond glycaemic control.
AstraZeneca’s legacy in cardiovascular
disease enables us to take a ‘whole
patient’ view of diabetes management
with a strong focus on delaying
cardiovascular complications and
maintaining cardiovascular health. Our
objective is for the treatment paradigm
to focus on early intervention, improving
disease control with the ultimate aim of
reducing the burden of cardiovascular
death and organ damage associated
with diabetes.
Through our exploration of novel, early
approaches to evolve the treatment
paradigm, AstraZeneca is committed to
getting diabetes patients to goal, sooner.
Working together, with policy change,
education and knowledge-sharing the
community can close the gap between
what can be done for people with
diabetes, and what is currently
being done.
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Disclaimer
While the foreword of this document was developed with the approval of the named author, the publication
as a whole has been developed by AstraZeneca. AstraZeneca retains full editorial control.
Foreword
Professor Stephen Colagiuri
Professor of Metabolic Health, Boden Institute of Obesity, Nutrition,
Exercise & Eating Disorders, Co-Director, WHO Collaborating Centre
on Physical Activity, Nutrition & Obesity
The world is in the grip of a global diabetes epidemic. In 2015 there
are 415 million people with diabetes and just under 50% (193 million)
are undiagnosed1. The rate of undiagnosed diabetes varies between
25% and 75%2 across regions and an estimated 75% of all people with
undiagnosed diabetes live in low and middle income countries3.
The health and financial impact of
diabetes affects not only the individual
with diabetes but also their family and
society in general, and is a global threat
to sustainable economic growth and
development. This burden is not shared
equally and particularly impacts low
and middle income countries which
are least well equipped to address it.
Positively, there is a considerable
and expanding evidence base that
this burden can be reduced through
strategies to improve the care of people
with diabetes, earlier diagnosis, and
preventing its development4. Evidence
shows that improved care can reduce
the development and progression of
diabetes complications and reduce
premature mortality, cardiovascular
disease, blindness, amputation and
end stage renal disease requiring
dialysis or transplantation5.
Early diagnosis and treatment are
key, and the evidence supporting the
benefits of early diagnosis is reviewed
in this publication by AstraZeneca,
which shows:
• The population at risk of developing
type 2 diabetes worldwide is already
vast, and growing
• Type 2 diabetes starts long
before symptoms present, yet by
identifying and addressing it early,
even before it develops fully, the
progression of symptoms can
be slowed, and even prevented,
reducing the risk of cardiovascular
complications and death
•S
uccessful programmes have been
proven to proactively diagnose and
address those at high risk early
•T
argeted prevention is recommended
in clinical guidelines across the world
as a sound investment
The frustrating aspect of diabetes
care and prevention is that we are not
translating this evidence into practice.
Barriers to implementation include
lack of awareness of diabetes and
its complications not only among
the general public but perhaps more
importantly among policy makers
and politicians6. Yet there are many
global examples of how to successfully
address and overcome these barriers.
With the number of people with
diabetes projected to increase to
642 million by 20407, we need to act
now, in partnership with a range of
stakeholders, to implement what we
know works. It is possible for the very
diverse health systems throughout
the world to adopt locally relevant
policies and programmes to reduce
the personal, societal and economic
burden of diabetes. Early detection
and multi-factorial treatment of
people with diabetes should be
a priority for everyone.
“The world is in
the grip of a global
diabetes epidemic”
“The rate of undiagnosed
diabetes varies between
25% and 75% across
regions”
“The frustrating aspect
of diabetes care and
prevention is that we
are not translating this
evidence into practice”
“Barriers to
implementation
include lack of
awareness of diabetes
and its complications
not only among
the general public
but perhaps more
importantly among
policy makers
and politicians”
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
1
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Contents
04
The personal and global burden
of diabetes
Undetected diabetes:
a global time bomb
06
The silent progression of a
devastating disease
Turning the tide of undiagnosed
diabetes through effective policy making
10
How can screening policies help
reduce undetected diabetes?
12
A window of opportunity – can the burden
of diabetes be reduced before diagnosis?
15
Making it happen –
early diagnosis in practice
Making it happen –
actions to take
24
Overcoming the barriers:
translating policy into action
The personal and
global burden of diabetes
Around 415 million people around the world are
living with diabetes, and five million people die from
the condition each year8. Affecting around 9% of the
world’s population and costing our health systems
12% of everything they spend, the global burden of
this disease is vast9.
Yet at a national, local and individual
level, a gap exists between what
should be done to manage this
condition and what is being done to
tackle type 2 diabetes. People continue
to suffer from the serious, costly
complications which have the potential
to be prevented, such as heart attack,
stroke, blindness, kidney failure and
amputations and, every six seconds,
someone dies from diabetes10.
90–95%
of all people with
diabetes have
type 2 diabetes
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90-95% of all people with diabetes
have type 2 diabetes, while 5-10%
of all people with diabetes have type
111. Type 1 diabetes is an autoimmune
condition that can develop at any age,
but usually appears before the age of
40. In this type of diabetes, the immune
system mistakenly attacks the cells
of the pancreas that produce insulin
(the hormone that processes glucose)
stopping production. In type 2 diabetes,
the body starts to resist the effect of
insulin, and gradually the production
of insulin declines.
With the number of people with type
2 diabetes growing in every country,
prevalence is set to increase to almost
640 million by 204012. Diabetes has
become a public health emergency
in slow motion13, and the challenges
associated with diagnosing and treating
those at risk are only set to increase.
Policy makers must heed the call to
action to change the course of type two
diabetes across the globe14.
Undetected diabetes: a global time bomb
The silent progression of a devastating disease
Across the world, many millions
of people have diabetes… but they
don’t even know it
Around 193 million people with diabetes do not know they
have the condition – that is almost half of the total global
population with diabetes15. They may be living without
any support to prevent major complications including stroke,
heart attack, blindness and amputations16. However, policies
can be implemented to detect diabetes early – before the
problems develop – to prevent or delay devastating
and costly complications.
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6
In a normally
functioning body, the
beta cells (ß cells) in
the pancreas produce
insulin. When someone
digests food, insulin
moves the glucose from
the food, which has
passed into the person’s
blood, into cells, where it
is turned into the energy
needed to function.
In type 2 diabetes,
the body is unable to
process the glucose
effectively. Two things
happen: the body
becomes less sensitive
to the insulin produced
(insulin resistance) and
there is a reduction in
the amount of insulin
produced. The body
cannot produce enough,
effective insulin to move
glucose out of the blood,
and needs help to
control the amount of
glucose remaining
in the blood17.
By the time someone realises they have diabetes…
it’s often too late
The body’s inability to produce enough effective insulin begins and continues
long before the patient is aware that anything is wrong: type 2 diabetes may
be present and affecting the body at least four years before a patient
receives a clinical diagnosis18. By the time people with diabetes receive
a diagnosis, as many as half have already developed one or more
diabetes-related complications19.
People at high risk need to be diagnosed as early
as possible in order to prevent complications
Once someone’s blood glucose levels reach the level for a diagnosis of diabetes,
our ability to influence the disease has reduced, and will continue to do so, as it
progresses, the disease worsens, and the condition becomes more complex20.
To address the costly burden of this disease – currently around 12% of total health
system spend – it is vital that policies target early detection and control in those
at greatest risk of diabetes, changing its course from the outset, by reducing
their chance of developing complications21.
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
7
Known risk factors for type 2 diabetes can help identify
and diagnose the condition, even in those patients who
have yet to develop outward symptoms
• Different ethnicities are at higher risk
of developing type 2 diabetes: South
Asian, Chinese, African-Caribbean and
people of black African descent are all
at increased risk in comparison to a
white population22
• Biology and family history can
also have a significant impact on a
person’s risk of developing type 2
diabetes. Genetics play a part in
the development of the disease for
many23, as do biological influences:
women diagnosed with diabetes
when pregnant are at higher risk
of developing type 2 diabetes
later in life24
• Prediabetes, where blood glucose
levels are elevated but not high
enough to reach the diagnostic criteria
for diabetes, is also a significant risk
factor. While it is not inevitable that all
people with prediabetes will progress
to a diagnosis of full diabetes, this
group is at high risk of developing
the disease, with 15–30% developing
diabetes within five years25
• Being overweight is also a key
risk factor, and the risk increases
exponentially as BMI increases
The risk of
developing
type 2 diabetes
increases
exponentially as
BMI increases
Body Mass Index & relative risk factor for type 2 diabetes in women
45
Relative Risk %
40
35
30
25
20
15
10
5
0
<23
23.0-24.9
25.0-29.9
Body Mass Index
Hu et al (2001)26
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30.0-34.9
>=35
Red blood cells.
Turning the tide through effective policy making
How can screening policies help reduce the
burden of undetected diabetes?
Proactive screening approaches are used internationally to diagnose
many undetected, serious and costly conditions27. Type 2 diabetes
is no exception: several national programmes have been established
around the world to detect and diagnose type 2 diabetes, enabling
healthcare professionals and patients to intervene early to prevent
and delay its associated complications28,29,30.
Effective
interventions
Many people
undiagnosed
Criteria for
successful
screening
Vascular
complications
Adapted from ADA (2015)31
Reliable
diagnostics
Early-diagnosed,
well-managed
diabetes
can prevent
complications32
A core challenge with type 2 diabetes
is the scale and cost of its associated
cardiovascular complications. Yet
by diagnosing and intervening early,
cardiovascular risk factors can be
reduced33. Targeted screening policies
therefore present an opportunity to
identify those at risk, test them for
diabetes, diagnose them, and get a
grip on their condition, long before it
leads to complications. So, when
should action be taken to target
early diagnosis?
Tests which may be used
to diagnose type 2 diabetes,
or prediabetes34
– Fasting plasma glucose (FPG)
– Two hour plasma glucose
(2-h PG)
– Oral glucose tolerance
test (OGTT)
– Glycated haemoglobin
(HbA1c)
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Turning the tide through effective policy making
A window of opportunity – can action be taken
before diagnosis?
By identifying people with increased glucose levels which have yet
to reach the point of diabetes (what many call prediabetes), their risk
of developing the condition can be reduced35. With around a third of
adults having prediabetes and the number rising36, the opportunity
for prevention in this group is vast. Most encouragingly for policy
makers, these people can be detected using the same approach
as for diagnosing diabetes.
The estimated increasing number of people with prediabetes (in millions)
by region among adults aged 20–79 for the years 2010 and 2030
180
160
140
Millions
120
100
80
60
40
20
0
Africa
Tabak et al (2012)37
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Middle East
and North
African
Region
Europe
2010
North
American
and
Caribbean
Region
2030
South and
Central
American
Region
South East
Asian
Region
(incl.
India)
Western
Pacific
Region
(incl.
China)
While the number
of people with
prediabetes is
rising, their risk
of developing
type 2 diabetes
can be reduced
by 58% if they are
identified early38
Landmark research such
as the US Diabetes Prevention
Program39 and the Diabetes
Prevention Study in Finland40 has
shown that intervening early in
patients with high glucose levels
“can substantially delay or prevent
the progression from impaired
metabolism to type 2 diabetes”41.
Screening detects
people who have
diabetes already,
and also identifies
those at high risk
of developing
the disease
People with prediabetes are identified in exactly the same way
that people with type 2 diabetes are detected42 and, by intervening
early, their risk of developing diabetes can be reduced by 58%43.
Health services can therefore use the window of opportunity
provided by screening to identify those with undiagnosed
diabetes, and those at high risk of developing it, long before
complications have the opportunity to take hold.
So, in light of the evidence around early detection and diagnosis
policies, what is being done around the world to put the
evidence into action?
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
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Making it happen – early diagnosis in practice
Targeted screening
approaches which have
been implemented to
diagnose diabetes early
Identifying others at high risk through screening
Different ways of detecting type 2
diabetes early have been adopted
around the world.
As clinics worked to identify people with undiagnosed diabetes, two people
with prediabetes and six people with a high cardiovascular risk score were
identified for every one person with confirmed diabetes54.
• The Finnish Type 2 Diabetes Risk
Assessment Form (FINDRISC),
has been used to screen and
detect those who may have type
2 diabetes as early as possible44
• Patient organisations such as
Diabetes UK45 in the United
Kingdom and the American
Diabetes Association46 in the
USA, have made tools available
online for healthcare professionals
to use as they engage with
patients, or to identify patients
to consider for further testing
In Denmark, The Netherlands and England, the ADDITION Study screened
patients within a primary care setting by targeting people aged 40–69 with no
known diagnosis of diabetes, but at high risk53.
Targeted screening finds more than diabetes
Diabetes
Prediabetes
• The Leicester Risk Assessment
score uses an electronic medical
record system for identifying those
to be tested – the test has proven
to be successful in identifying
a high yield of patients with
abnormal glucose levels, and
doing so within a more challenging
multi-ethnic UK setting47
• Other similar tests which have
been proven to work include: the
QDiabetes risk calculator tested
in England and Wales48, the
Cambridge Risk Score, used on
data from countries including the
UK and Denmark49,50, and the
AUSDRISK Tool51, advocated
and incentivised by the
Australian Government52
CV Risk
Lauritzen et al (2013)55
Using the same tests and efficient use of resources, it was possible to identify a
large number of patients with diabetes, at risk of diabetes, and at risk of other
conditions who would benefit from interventions that reduce their risk.
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
15
Local and national
approaches to
early diagnosis
policy are already
helping patients
across the world
Nationwide screening campaigns
Countries like the UK have adopted policies which use the same tests
to detect type 2 diabetes early and to detect, delay and prevent a range
of other conditions.
The NHS Health Check uses simple tests and questions to identify those
at high risk of developing heart disease, stroke, diabetes, kidney disease
and dementia to diagnose early. Each year, the programme is expected to
save 650 lives, prevent 1,600 heart attacks and strokes, identify at least
20,000 people with type 2 diabetes or kidney disease earlier, and prevent
4,000 people from developing type 2 diabetes56.
Age 40–75
Tests: BMI, blood pressure, cholesterol
Questions: age, ethnicity, smoking status,
family history, activity levels
At risk of diabetes?
Blood sugar tests
Early diagnosis
and action
NHS England (2015)57
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Heart disease,
stroke, kidney
disease, dementia
risk identified
Case Study: United States
Around 25% of overweight adults between the ages of 45–74
are estimated to have prediabetes in the US: 12 million people could
therefore benefit from interventions to reduce their risk of developing
diabetes, and slow its progression58. By targeting prevention at people
at high risk of diabetes, around 6.5 million people with undiagnosed
diabetes could also be identified, and get the chance to benefit
from early interventions59.
What action was taken?
The American Diabetes Association
recommends that all patients over
45 with a higher BMI should be
screened, to try to identify and
support those patients with abnormal
glucose levels60. A National Diabetes
Prevention Program has therefore
been launched aiming to offer, at
scale, the lifestyle modification
support shown to work in
large studies61.
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What are the expected
outcomes?
The programme is based on the US
Diabetes Prevention Program (US
DPP) which saw lifestyle interventions
such as individual counselling and
motivational support on effective diet,
exercise, and behaviour modification,
reduce the risk of developing diabetes
by as much as 58% across all
genders and ethnicities62.
How will it help policy
makers make a
difference?
The data collected during the
programme has fuelled further
research and understanding of the
best ways to delay, prevent and treat
diabetes63. Benefits of the US DPP
were still seen up to ten years later,
with prevention or delay of diabetes
persisting with continued good
practice by up to 34%64. The
National Program is expected to
have similar results.
Insulin granulae.
Dividing beta cells.
Improving system
outcomes
While trial results on system outcomes
have yet to be shown as statistically
significant, the evidence on screening
for early diagnosis in diabetes is
promising. The Ely study in the UK
suggests that screening may lead to
diagnosis on average 3.3 years earlier
than a non-screened population65.
Diabscreen, a study based in a group
of practices in the Netherlands, also
suggested a trend of greater long-term
cardiovascular risk reduction in people
diagnosed through screening, rather
than through normal clinical practice66.
The ADDITION trial, involving patients in
the UK, The Netherlands and Denmark,
explored the feasibility of screening in
primary practice. The findings67 and
modelling based on the results68 make
a strong case for a positive impact
of earlier diagnosis.
People with diabetes taking part in
this research in Denmark had the same
outcomes as people without diabetes:
similar mortality to a population of
the same age without diabetes69.
Modelling of the results also show
significant impact on the cardiovascular
complications that are associated with
diabetes: rapid diagnosis may reduce
risk of a cardiovascular event (such
as stroke or heart attack) by 7.5% in
absolute risk reduction and 29% in
relative risk reduction70.
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
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Case Study: Finland
With up to 50,000 Finns estimated to have undiagnosed
diabetes, a national programme was established in 2003
based on the positive findings of the Finnish Diabetes
Prevention Study71, which saw a 58% reduction in the risk
of getting diabetes through lifestyle modification72.
What was the
national strategy?
A range of organisations, from
government bodies to professional
associations, worked together to
address World Health Organization
recommendations while aligning
the programme with other national
priorities. Combined with a
population level strategy and a plan
for those at high risk, a strategy for
early diagnosis and management
was implemented to diagnose
and intervene early73.
What has been
achieved?
After two years, the incidence of
diabetes was less than half what
it was in the group who had no
interventions74. Risk of developing
diabetes was reduced by 36%,
persisting for years even after some
lifestyle interventions ceased75.
A range of materials have been
produced which enable other
countries to implement a
similar model76.
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Money well spent?
A comprehensive review of evidence on screening for diabetes concludes
that it is cost-effective for people aged 40–70 years, who have high
blood pressure, and are obese77. For many groups, the review found that
short term costs of screening were offset by lower treatment costs in the long
term, and one of the studies examined found that targeted screening (testing
in a population already found to have risk factors for diabetes) was more
cost effective than universal screening.
Studies across a range of countries have also explored the cost-effectiveness
of screening programmes in their population groups. In Canada, a modelling
study was used to identify that early screening for type 2 diabetes and
prediabetes to prevent or delay diabetes had both a positive public health
and economic impact by reducing the time and money spent on costly
complications78. In the UK, NICE has determined that by comparing the
disease burden with the quantity and quality of life lived (or ‘QALY’),
targeted screening is a good investment79.
For a measure to be considered
cost-effective within the UK system
it should cost less than £20,000 per
‘QALY’. Screening for diabetes and
prediabetes together, followed by
lifestyle interventions costs
£6,242 per QALY80
The evidence has resulted in national policies recommending costeffective screening programmes for type 2 diabetes and prediabetes.
In the UK, NICE determined that a national screening programme is not advised
as a ‘one size fits all approach’. However, as local classification and targeting
of high risk groups, followed by intensive lifestyle-change programme, is costeffective, they recommended that this approach should be considered by
local practices developing their own screening programmes81.
In the USA, the American Diabetes Association recommended that groups
at high risk should be tested at three year intervals, including those who
are overweight and aged 45 or over82.
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Delivering patient centred programmes
From a patient perspective, screening for diabetes is not associated
with any long-term harms at the population level83. In fact, people receiving
an early diagnosis gain an opportunity to seek treatment for, and reduce
the risk of, related conditions which may also pose a burden to their health.
Once addressed, the individual’s quality and length of life has the opportunity
to improve, for example, by losing weight and increasing mobility.
People with diabetes can also have longer to come to terms with their
condition through early diagnosis, and this may make them more likely
to engage with their diabetes care84. There is scope for healthcare
professionals to build a relationship with the patient over a long
period of time, providing more opportunities to achieve challenging
behaviour change interventions.
While patient anxiety should be minimised when giving an early diagnosis
which is unexpected – before a patient is aware anything is wrong – early
detection does not necessarily have a negative psychological consequence;
it may in fact activate behaviour change to reduce risk sooner85
and improve health outcomes.
By diagnosing type 2 diabetes early, benefits to both patients and health
services can be realised. So how can policy makers achieve this and
remove potential barriers to success?
Early diagnosis has a
positive impact from
both a public health and
economic perspective
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Making it happen – actions to take
While many are already acting on the evidence to change the
course of diabetes, as with all health interventions, there are practical
challenges associated with successful implementation. However,
by tailoring each initiative to the needs of local populations, focusing
on the long term benefits, and making the best use of resources
available, the course of type 2 diabetes can be changed.
Targeted early diagnosis in people
at high risk of type 2 diabetes has
been achieved in practice in several
different countries. The ADDITION
study successfully delivered a
screening programme in a primary
care setting across Denmark,
the UK and the Netherlands which
indicated a trend in the reduction
of cardiovascular risk86.
Policy makers
can take
inspiration
from countries
where effective
early diagnosis
strategies have
already been
implemented
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However, the ADDITION study also recognised implementation challenges
with, for example, a 50% response rate to screening questionnaires87.
By learning from other programmes to identify what works and for example,
understanding how to increase screening yield88, policy makers can overcome
the barriers to make an effective case for change:
• Understand local beliefs and attitudes to identify the
best approach for early action
Ensure uptake is strong by understanding the different socioeconomic89
and cultural contexts90, and the beliefs of the local population91
• Be realistic in expectations of what can be achieved
using the resources available
Programmes must be implemented appropriately, tailored according
to local population demographics, local expertise and the resources
available. The choice of which blood test to use to diagnose diabetes
will be one factor to consider, noting that some are more costly and
complex than others
• Make a sustainable case for investment
Manage expectations to accept initial increases in investment;
use the resources to focus on those at highest risk first, before using
the evidence to encourage wider roll out
• Tackle variation upfront
Programmes should be collectively coordinated to ensure consistency
in delivery and avoid variation in the quality of programmes delivered
• Plan ahead
Expect an increase in activity such as referrals (for example to
behaviour-change and lifestyle programmes); acknowledge these
in the planning phase and resource in advance
Should we
wait for more
evidence on
screening
from randomised
control trials
(RCTs)?
While the evidence on early
diagnosis in type 2 diabetes is
compelling, the debate about
national screening programmes
will continue in the absence of
more data. However, such data
may never be available due to the
limitations associated with RTCs
and screening for diabetes.
The ‘perfect’ study to examine the
impact of screening programmes,
can never be conducted in an
ethical way: it would mean ‘ignoring’
a proportion of those detected
through screening to identify the
different course they then follow.
If a healthcare professional knows
that someone has diabetes it
would be unethical not to try to
help them address their condition.
In the absence of a solution to
this challenge, existing evidence
should be acted upon, implementing
screening programmes for those
at high risk to tackle the immediate
challenges in type 2 diabetes.
Real world evidence can continue
to be collected to identify best
practice, and inform ongoing
research in the long term.
A range of early diagnosis resources
have been tried and tested across
different health systems
Many policy makers are already rising to the challenge, with international
initiatives such as the World Innovation Summit for Health92, and the European
Policy Action Network on Diabetes (ExPAND)93 maintaining momentum and
spreading best practice. Policy makers should use the wealth of evidence
and examples to take inspiration from countries where effective early
detection strategies have been implemented.
However, while global initiatives and existing national guidelines should
act as a catalyst for change – such as in the UK94, USA95, Canada96 and
Australia97 – different population groups and health systems will need to apply
different approaches to pragmatically tackle the burden of diabetes early in
their population. Realistic ambitions must be set for different populations.
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
25
How can policy makers in each nation
implement early diagnosis in type 2 diabetes?
National
commitments
must be made on
early diagnosis
in diabetes
AIM: Implement and support national guidelines for
diabetes screening (including detecting other disease
risks) and programmes for targeted prevention:
• ACTION: Set ambition levels in line with best practice but achievable
within the population group and resources available
• ACTION: Consider local targets for numbers of people enrolled in risk
reduction programmes for those at high risk of diabetes
• ACTION: Track and measure progress at a national level to ensure
consistent implementation locally
AIM: Be prepared to start
small and then build
on the success:
• ACTION: Align with existing
screening programmes for
other conditions which may
already be reaching similar
high risk groups
• ACTION: Pilot the screening
programme on a group of high risk
patients using engaged healthcare
professionals – prove the value of
the initiative before expanding to
broader population groups
Your pledge could be:
To establish a long term
action plan for early diagnosis
in diabetes – to first identify
25% in the adult population
at risk of diabetes within a
pilot population, before
reviewing the programme
and extending it to regional
or national roll out.
Asset ID: 889,853.011
Date of preparation: 6 October 2015
Date of expiry: 6 October 2017
26
Your pledge could be:
To publish new national screening guidelines by 2017, to reduce the
number of undiagnosed people with diabetes by 2025.
AIM: Capitalise on the opportunity to make the best
use of resources:
• ACTION: Target people at a high risk of developing diabetes – support those
with diabetes to change their course as they are identified
• ACTION: Identify a diagnostic approach which is feasible and effective in the
local population – use this as standard across the region to enable efficient
use of resources and comparable data
• ACTION: Use resources efficiently by addressing cardiovascular risk
and partnering with cardiovascular programmes – ensure cardiovascular
improvements are identified as outputs of any early diagnosis programmes
Your pledge could be:
To establish a formal collaboration, by 2017, between diabetes and
cardiovascular policy makers, experts, patient groups and those
involved with public health initiatives, to identify the most efficient
holistic model to improve patient outcomes.
Each nation should identify and
implement a locally appropriate
screening programme, with
consistently applied targets and
outcome measures, to intervene
early, slow symptom progression
and prevent complications where
possible. Early diagnosis in
diabetes must be championed
at national level to drive progress
and transform outcomes for
patients and health systems alike,
both in the immediate future
and beyond.
Some examples of resources which have been tried
and tested across the world:
NICE Guidelines
ADA Type 2 Diabetes Risk Test
ADA Standards 2015
QDiabetes Risk Tool
NHS Health Check
Finnish Risk Assessment Form
Diabetes UK Risk Tool
AUSDRISK Tool
Find out more about taking early action on diabetes here:
earlyactiondiabetes.com
A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
27
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A Call to Action for Early Diagnosis in Diabetes: Closing the gap between evidence, policy and practice
29
Asset ID: 889,853.011
Date of preparation: 6 October 2015
Date of expiry: 6 October 2017