Evaluation of the Diabetes Screening Component of a National Cardiovascular Risk Assessment Programme in England: a Retrospective Cohort Study

Raffaele Palladino,Eszter P Vamos,Kamlesh Khunti,Christopher Millett,Kiara Chu-Mei Chang,Azeem Majeed

doi:10.1038/s41598-020-58033-3

Raffaele Palladino, Eszter P Vamos + Show 4 more

Open Access

https://doi.org/10.1038/s41598-020-58033-3

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Abstract

Type 2 Diabetes (T2D) is increasing but the effectiveness of large-scale diabetes screening programmes is debated. We assessed associations between coverage of a national cardiovascular and diabetes risk assessment programme in England (NHS Health Check) and detection and management of incident cases of non-diabetic hyperglycaemia (NDH) and T2D. Retrospective analysis employing propensity score covariate adjustment method of prospectively collected data of 348,987 individuals aged 40–74 years and registered with 455 general practices in England (January 2009-May 2016). We examined differences in diagnosis of NDH and T2D, and changes in blood glucose levels and cardiovascular risk score between individuals registered with general practices with different levels (tertiles) of programme coverage. Over the study period 7,126 cases of NDH and 12,171 cases of T2D were detected. Compared with low coverage practices, incidence rate of detection in medium and high coverage practices were 15% and 19% higher for NDH and 10% and 9% higher for T2D, respectively. Individuals with NDH in high coverage practices had 0.2 mmol/L lower mean fasting plasma glucose and 0.9% lower cardiovascular risk score at follow-up. General practices actively participating in the programme had higher detection of NDH and T2D and improved management of blood glucose and cardiovascular risk factors.

Highlights

To the programme within the context of delivery within a health system with universal coverage, and with well-developed primary care and high penetration of electronic health records, presents an important opportunity to determine whether population-based screening for diabetes produces health benefit in real world settings
The mean diabetes risk score was 5.9 in the total study population with 17.7% of the individuals being at high risk of Type 2 Diabetes (T2D) (DRS ≥ 10)
Frequency of glycaemic testing was higher for patients registered with high coverage practices (low coverage practices: 54.9% of eligible population tested, mean number of tests per person 1.5 (2.4); high coverage practices: 66.7% of eligible population tested, mean number of tests per person 2.1 (2.9); Supplementary Table S2). 0.8% of the study population met the diagnostic criteria for non-diabetic hyperglycaemia (NDH) at baseline, while 7,126 cases (2.3%) were detected during the study period corresponding to an incidence of newly detected NDH of 0.23 per 1000 person-years

Summary

Introduction

To the programme within the context of delivery within a health system with universal coverage, and with well-developed primary care and high penetration of electronic health records, presents an important opportunity to determine whether population-based screening for diabetes produces health benefit in real world settings. General practices’ active engagement in the NHS Health Check programme may be associated with increased opportunistic screening outside of the programme that would not be captured by comparing attendees and non-attendees. This is supported by the finding of a national evaluation of the NHS Health Check that showed a strong underlying trend of improvements in the testing and management of CVD risk factors among those who did not attend the programme[24]. Similar analytical approaches are often used in policy evaluations as well as clinical trials (i.e. intention-to-screen analysis) to quantify benefits among people targeted by the intervention irrespective of their actual participation, providing an estimate of the effectiveness of the intervention[25]

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