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Risk assessment

Canadian taskforce releases diabetes screening guidelines

The Canadian Task Force on Preventative Health Care recommend that those most at risk of diabetes are screened annually. Photo: Flickr / National Guard
Guidelines recommend screening every 3-5 years for those at high risk of diabetes, and annual screening for those at very high risk
Authors find no evidence of improved outcomes from screening general population

New Canadian diabetes screening guidelines recommend regular testing for type 2 diabetes in high-risk and very high-risk adults, but stop short of advocating diabetes screening for the general population.

The new guidelines, published by the Canadian Task Force on Preventative Health Care and printed in CMAJ, update the previous edition, released in 2005. The document is available here.

The authors recommend using a risk calculator to determine the risk level for the general population, rather than applying a blood test across the board. They state that the Finnish Diabetes Risk Score (FINDRISK) is the preferred screening tool, with the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) as an acceptable alternative.

Those found to be at a high risk of diabetes should be screened every three to five years using a nonfasting A1C blood test, while those at a very high risk should be screened annually.

"These new guidelines bring precision and convenience with web-based risk calculators and nonfasting A1C to diabetes screening," states Dr Kevin Pottie, with coauthors. "Leveraging these tools will help improve health outcomes by empowering patients to take an active role in managing and modifying their own risk factors through interventions like diet and exercise."

The recommendation not to advocate screening for low to moderate risk adults came after the task force found no randomised trials or observational studies showing blood screening improving health outcomes in that group.

The choice of FINDRISK and CANRISK – which both measure diabetic risk by taking into account factors like age, obesity, history of elevated glucose levels, hypertension, and diabetes – was supported by evidence of internal and external validation, prospective research, test accuracy, and evidence of improved patient-important outcomes in clinical trials. FINDRISK was chosen as the primary screening test, as CANRISK has not yet been studied in clinical practice.

While the guidelines were designed to be used by family physicians, the authors also created a summary sheet to be used by other healthcare professionals, including nurses and dietitians.

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