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Risk of dysglycaemia high in people with other CVD risk factors

Risk of dysglycaemia high in people with other CVD risk factors

Publication date: Tuesday, 27 February 2018
Contributor(s): Jeremy Bray

The prevalence of previously undetected dysglycaemia is high in patients who are free from cardiovascular disease but have one or two other risk factors (hypertension and/or dyslipidaemia). A new study shows that using the FINDRISC questionnaire as a first step of dysglycaemia screening does not provide any benefit in this population.

The primary care arm of the EUROASPIRE IV study was carried out in 14 European countries including the UK. A total of 4579 patients without a history of CVD, coronary or other atherosclerotic disease, who had been prescribed blood pressure, lipid lowering or glucose lowering drugs were identified from general practice records. Of these, 2395 had full information on their hyperlipidaemia and/or hypertension without diabetes.

All these patients answered the FINDRISC questionnaire and had an oral glucose tolerance test (OGTT) and had their HbA1c measured.  FINDRISC is a scoring system that classifies the respondent as having a low, moderate, high or very high risk of developing type 2 diabetes during the forthcoming decade. If an individual is at a high or very high risk, an OGTT is recommended for further investigation.

Study results showed that the FINDRISC scores predicted diabetes or impaired glucose tolerance (IGT) accurately in these patients (Table) when measured by OGTT. According to the OGTT, 39% of these patients had previously undetected dysglycaemia.

Fasting plasma glucose (FPG) was found to be the best test for detecting diabetes in these patients. The study showed that the OGTT identified 92% of patients with type 2 diabetes, fasting plasma glucose (FPG) + HbA1c 90%, FPG 80%, 2-hour post-load plasma glucose 29% and HbA1c 22%. The authors noted that even if fasting plasma glucose is the best single test for detecting type 2 diabetes it still leaves a considerable proportion of patients with dysglycaemia undetected. They suggested a pragmatic strategy which decreased the demand for an OGTT by 21%, was to screen all patients with FPG followed by OGTT in patients with impaired fasting glucose.

FINDRISC risk categories

Dysglycaemia (T2D or IGT) according to OGTT

Low

20%

Slightly elevated

34%

Moderate

41%

High

49%

Very high

71% 


ACTION
 

Hidden dysglycaemia is very common in patients being treated for hypertension and/or dyslipidaemia. Primary care needs to find the best screening methods to diagnose these at-risk patients and allow early initiation of appropriate treatment.

Topics covered:
Category: Evidence in Practice
Edition: Volume 3 Number 2 PCCJ Online 2018
Contributor(s): Jeremy Bray

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