Knowledge of the risk factors, and signs and symptoms of diabetes and pre-diabetes may help increase awareness about the need to be tested for diabetes. Individuals, family members, friends, health care providers, schools, the media, community organizations, health insurance providers, employers, as well as local, state, and federal governments all play important roles in helping to ensure that at-risk or asymptomatic individuals are screened for diabetes.65
65 The USPSTF concludes that the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose. The USPSTF does recommend screening for type 2 diabetes in adults with hypertension or hyperlipidemia (see http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm. for more information). The generally accepted standards of care for diabetes screening can be found at: http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s11#SEC3
Individuals and Family and Friends
People at risk for diabetes and their family and friends can be actively involved in ensuring that diabetes is diagnosed early. Individuals may be able to recognize diabetes symptoms for themselves, or a friend or family member may recognize these symptoms in a loved one and encourage that person to get tested for diabetes. The following are some steps that can help to identify people at risk for diabetes:
- Take a self-administered type 2 diabetes risk assessment test (see Appendix D) to determine individual risk for diabetes and important next steps. Discuss the results with a health care provider.
- Pregnant women should ask their health care provider if a diabetes test is needed.
- Individuals with pre-diabetes should work with their health care provider to develop a plan to help delay or prevent the onset of type 2 diabetes. Even if blood glucose levels do not indicate diabetes, pre-diabetes is a risk factor for developing diabetes. Losing a small amount of weight by eating a healthier diet and getting regular exercise may prevent or delay the onset of type 2 diabetes.
- Encourage family members and friends with diabetes symptoms to seek medical help. Talk with a health care provider or local office of the American Diabetes Association to learn how to support someone who may be at risk for diabetes.
Health Care Providers
Different types of medical providers, such as doctors, physicians’ assistants, nurse practitioners, nurses, diabetes educators, registered dietitians, and pharmacists can play critical roles in helping to detect diabetes. Here are some things providers can do:
- Gain and maintain state-of-the-art knowledge about the risk factors for diabetes and pre-diabetes and effective strategies related to testing for and diagnosing the disease. For example, the diagnostic glucose numbers for diabetes and pre-diabetes have been revised in the past few years (See “The Importance of Early Diabetes Detection” in this section for current diagnostic glucose numbers).
- Create opportunities within the health care setting to identify persons at high risk for diabetes, such as asking patients to provide information about diabetes symptoms and risk factors on a pre-visit questionnaire. Knowing a patient has symptoms or risk factors for diabetes can serve as an important prompt for diagnostic testing.
- Assess risk for gestational diabetes. The American College of Obstetricians and Gynecologists (ACOG) advises that it is appropriate to screen all pregnant women for gestational diabetes, whether by patient history, clinical risk factors for gestational diabetes, or a laboratory test to determine blood glucose levels. However, ACOG acknowledges that more research is needed before it can be determined what screening method is best and when it should occur.66 The U.S. Preventive Services Task Force concludes that evidence is insufficient for or against routine screening for gestational diabetes.67
- Establish and implement protocols to ensure that newly diagnosed patients with diabetes are (1) promptly educated about lifestyle changes and diabetes selfmanagement techniques that can delay or prevent complications of diabetes; (2) tested when appropriate for comorbid conditions, such as eye or cardiovascular disease; and (3) involved in developing a plan to control HbA1c, blood pressure, and cholesterol, the “ABCs of diabetes.”68
- Refer patients and provide contact information as needed to additional health care providers to address specific or urgent problems.
- Be a diabetes messenger and help to educate patients and community members about the risk factors and signs and symptoms of diabetes and encourage behavior change. Share information about diabetes detection with community leaders.
- Become involved in research aimed at identifying effective approaches to detect diabetes in various populations, such as children, older persons, and members of specific racial/ethnic groups.
66 American College of Gynecologists. (2001). Pregnant women should be screened for gestational diabetes: Though no one test is ideal. Press release, August 31. Available at: http://www.acog.org/from_home/publications/press_releases/nr08-31-01.cfm. August 31, 2001.
67 U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: Recommendations and rationale. (February 2003). Agency for Healthcare Research and Quality, Rockville, MD. Available at http://www.ahrq.gov/clinic/3rduspstf/gdm/gdmrr.htm.
68 National Diabetes Education Program. Guiding principles for diabetes care: For health care providers. NIH Publication No. 99-4343. Available at: http://www.ndep.nih.gov/diabetes/pubs/GuidPrin_HC_Eng.pdf.
Employers can play a key role in educating their employees about the risk for diabetes and encouraging them to be screened and/or tested for the disease. By working with the National Diabetes Education Program,69 some employers have become the central nexus for improved detection:
- Distribute information about diabetes and its risk factors and signs and symptoms to employees and their families.
- Partner with the health department or other local organizations to provide work-site diabetes screening and strongly encourage individuals who indicate a high risk for diabetes to be tested for the disease.
69 The National Diabetes Education Program is a jointly funded program by the National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce morbidity and mortality associated with diabetes.
Communities and Local Health Departments
Community organizations and local health departments can play an important role in diabetes education and detection. Various local organizations (e.g., federally supported health centers, the local chapter of the American Diabetes Association, faith-based organizations, etc.) along with the local health department may be valuable resources to help develop and/or distribute information on the importance of early diabetes detection and the risk factors for and signs and symptoms of diabetes. Some action steps for community organizations include:
- Encourage local organizations to disseminate information, such as copies of diabetes risk assessment tests, through their various communication channels. Examples of potential partnerships include vendors placing diabetes information on shopping bags; local utility companies including inserts into mailings; and churches, synagogues, and other faith-based organizations placing diabetes risk assessment tests in their newsletters, bulletins, or other mailings.
- Organize outreach sessions at community venues such as libraries that can provide space, equipment, and other resources for community-wide presentations on diabetes detection, including risk factors, signs and symptoms, and action steps for individuals who think they might have the disease.
- Develop a directory of community resources for diabetes screening, testing, and treatment that can be distributed to people at high risk for diabetes.