Screening for Type 2 diabetes mellitus in the UK Indo-Asian population

Abstract

Aims: Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self-testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects.

Methods: Caucasian and Indo-Asian subjects aged 35-70 years in two general practices in Leicester (n=9896 (6198=Asian subjects, 3698=Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self-test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname.

Results: Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty-nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty-three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35-70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian).

Conclusions: Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35-64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.