The Prevalence of Undiagnosed Diabetes Has Not Decreased in Spite of Increased Screening in an Australian Rural Area

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In the mid-2000s in Australia, national guidelines were introduced to promote diabetes screening in people aged 40+ years. We have tested whether diabetes screening has increased, and the prevalence of undiagnosed diabetes has decreased since the introduction of these guidelines. ’Crossroads’ is a repeat cross-sectional study conducted between 2000-2003 (Crossroads-I) and then 2016-2018 (Crossroads-II) in rural Australia (the Goulburn Valley, Victoria). Households visited were randomly selected, and the same households were then revisited in Crossroads-II, alongside proportionately randomly selected new houses. All adult residents are interviewed face to face by trained research assistants. Questions enquire about diabetes status, occurrence of diabetes screening in last 2 years and primary care utilisation. Randomly selected participants are invited to attend a ’clinic’ including a glucose tolerance test. The Crossroads-I cohort (n=3787) was younger and had a higher proportion of male participants than the Crossroads-II cohort (n=1733) (44 ± 17 vs. 53 ± 19 years p<0.0001, 46% vs. 42% male, p<0.0001). The age standardised prevalence of self-reported diabetes (7.0% vs. 5.4%, p<0.05), and age standardised screening rates (56.5% vs. 49.7%, p<0.05) were higher in Crossroads-II than Crossroads-I. Crude undiagnosed diabetes prevalence was also higher in Crossroads-II than Crossroads-I (17/430 (3.9%) vs. 15/814 (1.8%) p<0.05). Primary care utilisation was higher in Crossroads-II than I (6.4 vs. 4.7 visits in past 12 months, p<0.0001) and waiting times were shorter (3.0 vs. 3.9 days, p<0.0001). We conclude that diabetes screening has increased in this area in association with improved access to primary care, and guideline changes. Despite this, rates of undiagnosed diabetes have also increased in line with the overall prevalence of diabetes. Additional strategies are required to reduce undiagnosed diabetes rates further. Disclosure D. Simmons: Speaker's Bureau; Self; Roche Diabetes Care Health and Digital Solutions, AstraZeneca, Novo Nordisk Inc., Medtronic. K. Glenister: None. D.J. Magliano: None. S.J. Wright: None. L. Bourke: None.