Screening of blood samples from the UK Biobank identifies thousands of undiagnosed cases of type 2 diabetes

A study of approximately 200,000 blood samples from the UK Biobank has identified more than 2,000 undiagnosed cases of type 2 diabetes. The study, presented at this year’s Annual Meeting of the European Diabetes Study Group (EASD), does not report data from the UK Biobank to participants, so an average of 2 undiagnosed diabetics Due to the clinical diagnosis that had been waiting for more than a year, and about a quarter remained undiagnosed after 5 years.

A study by Dr. Catherine Young and colleagues at the University of Exeter and the Royal Devon and Exeter NHS Foundation Trust in the United Kingdom used tests for monitoring glycemic control and diagnosing diabetes, known as HbA1c or “glycated” hemoglobin. did. In the UK, type 2 diabetes is mainly diagnosed by the HbA1c test.

Dr. Young said: “People can have type 2 diabetes for years without any symptoms, which can delay diagnosis and increase the risk of complications. In our study, population-level screening can lead to type 2 diabetes. Cases of diabetes can be identified much earlier and may reduce complications. ”

The UK Biobank is a cohort of approximately 500,000 participants between the ages of 40 and 70 at the time of recruitment, with nearly half of the participants having access to primary care records (clinical code and prescription data). At the UK biobank, all participants were actually screened for diabetes because HbA1c levels of participants were measured in blood samples collected at the time of recruitment, but the results were reported to them and medical professionals. did not. This is perfectly normal as volunteers who agree to participate in the UK Biobank project agree not to receive feedback on the results.

The authors analyze how many additional people with diabetes can be identified by population screening using HbA1c, and how much screening reduces the time to diagnosis of diabetes compared to current approaches. Did.

The authors defined participants who were not diagnosed with diabetes at the time of recruitment as: a) did not self-report diabetes. And b) There were no signs of diabetes in pre-recruitment primary care records (clinical code for diabetes, HbA1c measurements above 48 mmol / mol, or prescriptions for hypoglycemic agents).

Undiagnosed diabetes was defined as diabetes with a UK biobank HbA1c reading of 48 mmol / mol or higher. For participants with undiagnosed diabetes, the authors then examined the time taken to actually receive a clinical diagnosis in primary care records, and the diabetes diagnostic code, HbA1c, 48 mmol / mol or higher, or higher. Prescription for glucose lowering drugs.

Of the 201,465 UK Biobank participants who had primary care records available, HbA1c measured at recruitment and had not been pre-diagnosed for diabetes, 2,022 (1.0%) had undiagnosed diabetes screened by HbA1c. I was suffering from.

People with diabetes who are not diagnosed by screening are older (61 vs. 58 years), more likely to be obese (BMI 31.0 vs. 26.6), and men (60% vs. 45%) than those without diabetes. Often there are. Statistical modeling shows that it took an average of 2.3 years after hiring UK Biobank for these participants to be diagnosed with diabetes, and that 23% had not yet been diagnosed with a 5-year follow-up. I did.

Dr. Young concludes: “Screening with HbA1c identified an additional 1.0% of the population aged 40-70 years with undiagnosed diabetes. This screening diagnosis took about two years before a clinical diagnosis was made. 23% Not yet diagnosed after 5 years. Identifying these patients with primary care records at UK Biobank provides a unique opportunity to study the impact of this delay on the risk of developing future complications. I will. “

“Preliminary diagnosis suggests that delays in diagnosing undiagnosed diabetics did not significantly affect diabetes-related complications in this group of people, but in this age group of diabetics. Further research is needed to see if screening reduces diabetes Related complications. “

This study is funded by Professor Andrew Hattersley’s Novo Nordisk Foundation Diabetes Excellence Award.

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