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Screening tests for T2 diabetes

ButtterflyLady

ButtterflyLady

Well-Known Member
Messages
3,290
Location
New Zealand
Type of diabetes
Treatment type
Tablets (oral)
Dislikes
Acceptance of health treatment claims that are not adequately supported by evidence. I dislike it when people sell ineffective and even harmful alternative health products to exploit the desperation of people with chronic illness.
I have a question for @Southport GP but everyone feel free to discuss it too :)

Hi Southport GP

It's great to see a GP participating in this forum and doing research on diabetes. Much appreciated!

I know you will be busy so I understand if you may not be able to respond, but I wanted to ask for your opinion on HbA1c testing for T2 diabetes screening in the general population where there are risk factors such as age, BMI, hypertension, family history etc.

The NZ guidelines favour HbA1c for this purpose ahead of fasting BG or OGTT, with the usual caveats about those patients for whom HbA1c is inappropriate or where an additional OGTT would be useful. See pp. 46-47 of these guidelines:
https://www.health.govt.nz/system/files/documents/publications/nz-primary-care-handbook-2012.pdf

Personally I found the OGTT pretty unpleasant because my blood glucose swung around wildly and made me feel unwell. I am happy to go for a fasting BG test but some patients being screened for the first time may not go for the test as it is inconvenient. So, HbA1c may be more convenient for more people, and therefore a more useful screening test?

In the UK doctors seem to use FBG and OGTT more than HbA1c for screening. Do you think there should be a move to using HbA1c as the first option? Is it more expensive than the other tests?

Thanks
 
Well I'm not sure where your info has come from.. I was diagnosed on an HbA1c test in Dec 2014
 
I was misdiagnosed, first because of my high finger prick reading then my Hba1c, it wasn't until I had good control that my hba1c dropped into normal levels and stayed there, unless, too many carbs. Then hypos!
If you work on your hypothesis, my reading, because of the recommended diets I would be still assumed to be diabetic!
Without OGTT, you cannot diagnose the spike and the drop back to your average diabetic range. Or not in my case. Two hours is enough in diabetics, but prolonged for RH!
An OGTT is used for much more than tracking blood glucose levels. Or seeing if you are diabetic or not!

Surely a diagnosis of various tests to eliminate other possibilities and to try and get the right treatment for diabetics, is better than having one standard test or level to give GPs a better idea what is going on.
Dsns should be able to use tests, rather than relying on what they are taught to help diabetics.
I do believe, having been through it all that because most diabetics (T2) don't get to see a specialist and therein lies a big problem.
There is probably better educated (in diabetics) in the treatment of diabetes on this forum than most diabetics ever see in there whole life.
The education is there, it's all not done right, and it's all to do with the government trying to save money spent on the health service.
When in the long run it will cost a lot more!
 
Similarly, I was told the HbA1c is the "Gold Standard" for T2 these days. In proportional terms I don't "see" many having the OGTT, partly, I'm guessing, because it will be expensive. I don't mean the blood tests are necessarily expensive, but that the supervision for at least 2 hours with blood harvesting required at fairly tight timelines.

That said, I understand that at my County's Diabetes Centre, they no longer test the 30 and 60 minutes slots because (and I quote", "even non-diabetics can go to double figures at those times.

I had a fasting test, as part of an overall panel, then a subsequent HbA1c following the elevated fasting score.

These are my county's guidelines to GPs.
 
If I n the case of RH, where we spike very quickly, the test would miss this and only a prolonged test can verify anything other than diabetes.
Once again money over proper testing and treatment is this government ideology!
 
nosher8355 said:
If I n the case of RH, where we spike very quickly, the test would miss this and only a prolonged test can verify anything other than diabetes.
Once again money over proper testing and treatment is this government ideology!
Click to expand...

Obviously, nosher, there are circumstances under which almost any diagnostic tool will be sub-optimal, like using an HbA1c where certain blood disorders are known to exist, or in pregnancy for gestational diabetes. One might like to think that although, in most cases, the HbA1c is just fine that the requesting GP would apply a certain amount of expertise and logic to the process.
 
You would think that, and so would I, but unfortunately, as in my case, the training in our health care providers, which included a diabetic specialist GP, completely misdiagnosed a blood glucose disorder of which I have. The number of T2 diabetics that don't see a specialist or consultant wouldn't happen in any other condition!
The lack of knowledge and the impersonal nature of the treatment is truly criminal.
How many times have you read a newbie poster, being confused and totally bewildered about the care given by our surgeries, left to their own devices on how and what to eat and the first thing doctors do is medicate and leave the patient to eat more or less what they want.
When clearly, it is what they are eating is doing the damage.
Education is imperative in controlling blood glucose conditions, T2s are consistently deprived of this basic care.!

Because of politics and ignorance. And profit!
 
nosher8355 said:
You would think that, and so would I, but unfortunately, as in my case, the training in our health care providers, which included a diabetic specialist GP, completely misdiagnosed a blood glucose disorder of which I have. The number of T2 diabetics that don't see a specialist or consultant wouldn't happen in any other condition!
The lack of knowledge and the impersonal nature of the treatment is truly criminal.
How many times have you read a newbie poster, being confused and totally bewildered about the care given by our surgeries, left to their own devices on how and what to eat and the first thing doctors do is medicate and leave the patient to eat more or less what they want.
When clearly, it is what they are eating is doing the damage.
Education is imperative in controlling blood glucose conditions, T2s are consistently deprived of this basic care.!

Because of politics and ignorance. And profit!
Click to expand...

I have no issue with some of your post, and I do appreciate you've had a particularly rocky road with your RH.

Where I would perhaps take issue is surrounding your statement, "The number of T2 diabetics that don't see a specialist or consultant wouldn't happen in any other condition!". Doubt that's entirely accurate, given the multitude of epidemics the UK is currently creaking under - hypertension, fatty liver, stress, back pain, arthritis, asthma and so on. For those suffering from those conditions, they are just as emotive as diabetes is to us.

I still believe that the vast majority of GPs want to do a good job, but are unable to keep up with all the developments in all the fields for all the epidemics. There is much talk about the number of unfilled GP training places these days. Junior doctors just don't want to go into a specialism (as a GP is a specialist in their own area) where they are always under immense pressure; seeing far more patients per hour and day than makes credible sense. I certainly wouldn't do it.

I feel myself fortunate to be registered in a practise where I believe the professionals care, but as I recognise the foregoing, I always prepare for my appointments to ensure I achieve my objective as often as I can.

Of course, it's really not ideal, but at least we have access to medical care 24/7, free at the point of delivery. Can you imagine your struggle if it was costing you several hundreds of pounds every time you attended your doctor? Can you imagine someone close you, discovering a breast lump or something similar, and you both being worried sick, not only about the potential outcome, but just how you're going to afford the various tests in order to reach diagnosis, never mind the potential for years of treatment? And worse still, can you imagine being in a situation where someone develops something like T1, and is literally doomed, because they have no way of paying for insulin, never mind test strips or the checks we take for granted.

It is sad that commercialism and health have gotten a bit muddled up in some fields, but knowledge is power. We need to look after ourselves, rather than bask in the false belief that the Nanny State will look after us without any problems whatsoever.
 
It shouldn't be down to money!
But we all pay through taxation and national insurance, and I am still paying far too much of my share. With respect to my pay and working life.
The government is elected I naively thought to look after its people, notice I didn't say citizens, but I could say subjects of the crown, in our so called democracy!
But that's politics!

Even if you pay, you still see the same doctor, they give the same advice and there is no benefit of the patient! Only if you a specialist endocrinologist can you get a proper diagnosis for many blood glucose disorders. You are just lumped in with the rest of the ignored T2s.

The nanny state is propaganda. Just spin. It doesn't exist!

Ok, but because, I have a large family and out of six people when I was growing up in our house, two are now living. Cancer, malaria, diabetes,and strokes have taken the others.
I have paid for my mother's care, at point of contact, for help for her living an independent life until her third stroke, she lived in her mid eighties. My wife is disabled and cannot claim, even though she is fully paid up on her stamp. I have to work to pay the bills, my kids have to work and help out with things whilst I'm at work, her father is disabled and we have to fork out for his care. It's great this system isn't it! This government has intentionally targeted the infirm and disabled. Because of dogma. It is systematically destroying the best ever health care system, the world has ever known. Every other country is jealous, even the US is going towards it.!!!!
I hate politics and especially the politicians that are more interested in spin, than actually doing something, the kick in the **** that Labour is experiencing is just the start of a more diverse culture shock that this so called democracy really needs.
I hated posting this but my story and my life and struggle epitomizes this government attitude to its people.
 
I remember my ex Father In law being diagnosed with diabetes in the late 1970's/early 1980's. Little pee on sticks ( dipsticks) were put through letter boxes and people in the households, did just that. That is how he was aware something was not right and then went to see his GP because of the results.
 
@CatLadyNZ I don't know where you get your information from.

You only have to read the posts from UK newbies on these forums to see that the vast, vast majority are diagnosed with an HbA1c, often following a suspicious FBG test done on a routine review. I personally was diagnosed following an HbA1c on a routine over 60's review, which was followed by a second HbA1c ten days later. (January 2014). I should add here that now all over 45's are invited for these reviews.

I haven't once felt I was receiving sub-standard care. I feel very well looked after. I exclude dietary advice from this, which goes without saying, although within the current NHS guidelines, I did get all the dietary advice about the Eatwell Plate and a place on the X-pert course.
 
It was in 2011 that the World Health organisation recommended the use of HbA1c for diagnosis. It wasn't possible before because of the lack of International standardisation . Soon after British GPs were told to switch. http://www.pulsetoday.co.uk/clinica...g-for-diabetes-diagnosis/12341186.fullarticle
They still use a OGTT for gestational diabetes because an HbA1c wouldn't reflect recent changes.

There are also over 40 health checks where people at risk can be screened for diabetes http://www.nhs.uk/conditions/nhs-health-check/pages/nhs-health-check-questions-faq.aspx
(and there were doctors who did this long before they became regularised. I remember going in for my CS when I was about 45 ie 17 years ago. The doctor insisted that it was important for me to have such a check. That's how I know that my glucose and everything else tested was perfectly normal then.)
 
Last edited by a moderator:
Andrew Colvin said:
Well I'm not sure where your info has come from.. I was diagnosed on an HbA1c test in Dec 2014
Click to expand...

My info comes from this forum, where I've read of several people saying they were screened with FBG even if then diagnosed with HbA1c. My statement was "In the UK doctors seem to use FBG and OGTT more than HbA1c for screening."
 
Bluetit1802 said:
@CatLadyNZ I don't know where you get your information from.

You only have to read the posts from UK newbies on these forums to see that the vast, vast majority are diagnosed with an HbA1c, often following a suspicious FBG test done on a routine review. I personally was diagnosed following an HbA1c on a routine over 60's review, which was followed by a second HbA1c ten days later. (January 2014). I should add here that now all over 45's are invited for these reviews.

I haven't once felt I was receiving sub-standard care. I feel very well looked after. I exclude dietary advice from this, which goes without saying, although within the current NHS guidelines, I did get all the dietary advice about the Eatwell Plate and a place on the X-pert course.
Click to expand...
Of course you wouldn't know where I got my info from because I didn't say. It's actually from this forum. You seem to have fallen into the same trap as Andrew Colvin, by confusing screening with diagnosis. What I said was "In the UK doctors seem to use FBG and OGTT more than HbA1c for screening."

I'm not talking about "substandard care" after diagnosis at all. I was simply asking a UK GP for his views on screening.
 
phoenix said:
It was in 2011 that the World Health organisation recommended the use of HbA1c for diagnosis. It wasn't possible before because of the lack of International standardisation . Soon after British GPs were told to switch. http://www.pulsetoday.co.uk/clinica...g-for-diabetes-diagnosis/12341186.fullarticle
They still use a OGTT for gestational diabetes because an HbA1c wouldn't reflect recent changes.

There are also over 40 health checks where people at risk can be screened for diabetes http://www.nhs.uk/conditions/nhs-health-check/pages/nhs-health-check-questions-faq.aspx
(and there were doctors who did this long before they became regularised. I remember going in for my CS when I was about 45 ie 17 years ago. The doctor insisted that it was important for me to have such a check. That's how I know that my glucose and everything else tested was perfectly normal then.)
Click to expand...
British GPs may have been told to switch, but based on the reports from some forum users, several recently screened people have said the first test was FBG. It's not a biggie, really. Just that I wondered why FBG was used for screening rather than HbA1c. Just looking for the most cost effective, useful, and convenient option. I happen to think that except in those cases where HbA1c is not reliable, it seems to be more useful than FBG, and is more convenient for the patient, possibly leading to higher uptake.
 
AndBreathe said:
Similarly, I was told the HbA1c is the "Gold Standard" for T2 these days. In proportional terms I don't "see" many having the OGTT, partly, I'm guessing, because it will be expensive. I don't mean the blood tests are necessarily expensive, but that the supervision for at least 2 hours with blood harvesting required at fairly tight timelines.

That said, I understand that at my County's Diabetes Centre, they no longer test the 30 and 60 minutes slots because (and I quote", "even non-diabetics can go to double figures at those times.

I had a fasting test, as part of an overall panel, then a subsequent HbA1c following the elevated fasting score.

These are my county's guidelines to GPs.
Click to expand...
I don't see the benefit in OGTT except for GD and testing for RH and any other unusual conditions. But I've read on the forums that other people have had OGTTs and not HbA1cs, which seems a bit odd. Oh well.
 
phoenix said:
Nice guidelines to risk assessment and screening for T2
https://www.nice.org.uk/guidance/ph38/chapter/1-Recommendations
Click to expand...
Thanks, one purpose of my thread was to find out what UK doctors are supposed to do. Of course we know that (for people anywhere) there is often a lag in uptake of new recommendations. I wonder if those doctors are just doing what they are familiar with, or if they have considered which test they think is better for screening and to them it's FBG, or if it is actually cheaper?
 
For people who are asymptomatic, or having tests for other things (which may of course require fasting in themselves), sometime a general fasting panel seems to be recommended. This is what happened with me.

On receipt of the first set of results, with the unexpectedly elevated fasting blood glucose, I was sent for an HbA1c, and Bingo!
 
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