Screening for glucose metabolism disorders: a comprehensive review

There is an epidemic of Type 2 diabetes. It is predicted that by 2030 that the number of those with Type 2 diabetes will rise to over 350 million globally. There has been much debate regarding the cost effectiveness of early intervention in Type 2 diabetes. Studies have shown that despite ' intensively' treated patients serious complications still occur. Research indicates there is demonstrable and quantifiable insulin resistance and either impaired fasting glucose or impaired glucose tolerance for 5 to 10 years before the onset of Type 2 diabetes. It is in this state of a glucose metabolism disorder there is an opportunity to prevent or delay the onset of diabetes. This project provides a comprehensive review of the contemporary research literature to answer the question What is the best test to screen adults for glucose metabolism disorders, for earliest possible detection in a primary care setting in Canada . A review of 71 studies identified strengths and weaknesses of a variety of screening modalities. The key finding was that the Oral Glucose Tolerance test (OGTT) is the most sensitive test in all populations for identification of glucose metabolism disorders. It is also clear that despite recommendations by contemporary clinical guidelines, the use of HbA1c is ill suited to identification of glucose metabolism disorders. It is therefore recommended that the OGTT be used were feasible in testing for glucose metabolism disorders, preferably with plasma insulin levels being done at the same time to facilitate the use of an insulinogenic index. If this is not possible, consideration should be given for using glucose challenge testing or Hba1c and fasting plasma glucose in combination. The Nurse Practitioner, along with other primary health care practitioners, is in an ideal position to intervene in the disease trajectory through effective screening and patient education. Interventions have the promise of improving patient and health system outcomes and reducing the future personal and financial