Cardiometabolic profile of people screened for high risk of type 2 diabetes in a national diabetes prevention programme (FIN-D2D)

Abstract

Aims

To study screening of high-risk individuals as part of a national diabetes prevention programme in primary health care settings in Finland between 2003 and 2007, and evaluate the cardiometabolic risk profile of persons identified for intervention.

Methods

High-risk individuals were identified by the Finnish Diabetes Risk Score (FINDRISC), history of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), cardiovascular disease (CVD), or gestational diabetes. Participants subsequently underwent an oral glucose tolerance test. CVD morbidity risk was estimated by the Framingham Study Risk Equation and CVD mortality risk by the Systematic Coronary Risk Evaluation Formula (SCORE).

Results

A high-risk cohort of 10,149 (of whom 30.3% men) was identified (mean age 54.7 for men, 53.0 for women). Altogether 18.8% of men and 11.5% of women had screen-detected diabetes. In total 68.1% of men and 49.4% of women had abnormal glucose tolerance (IFG, IGT or screen-detected diabetes). Furthermore, 43.2% and 41.5% of men, and 13.3% and 11.3% of women, respectively, had a high predicted risk of CVD morbidity or mortality.

Conclusion

Prevalence of dysglycemia including undiagnosed diabetes and the predicted risk for CVD was alarmly high in the identified high-risk cohort, particularly in men.

Introduction

Type 2 diabetes can be delayed or prevented by treating people with dysglycemia by means of lifestyle intervention or medication, as shown by major clinical trials of diabetes prevention [1], [2], [3], [4], [5]. Translating this message from the clinical trials to clinical practice is an urgent challenge but, surprisingly, has not yet been achieved at a population level extensively anywhere [6], [7], [8], [9], [10], [11], [12], [13]. Special screening models are called for in primary health care in order to identify those at an increased risk of diabetes, and those who actually already have undetected diabetes, and to be able to refer them for effective interventions. Otherwise, the true primary prevention of diabetes and late complications related to hyperglycemia, elevated blood pressure and elevated cholesterol levels will not be possible.

To meet this challenge the first large scale national Programme for the Prevention of Type 2 Diabetes was launched in Finland [14]. It was based on evidence derived mainly from the Finnish Diabetes Prevention Study and was implemented through the FIN-D2D project between 2003 and 2007 in the Finnish primary health care [15], [16]. FIN-D2D included population-, high-risk- and early treatment strategies. The high-risk strategy was directed to implement screening and lifestyle interventions of people at high risk of type 2 diabetes as part of routine primary health care, aiming for diabetes prevention and cardiovascular (CVD) risk factor reduction.

In the current study we assessed (1) how the screening for high-risk individuals in the primary health care setting was carried out in FIN-D2D and (2) what the cardiometabolic risk profile of persons identified for intervention was.