Who attends a UK diabetes screening programme? Findings from the ADDITION-Cambridge study.
OBJECTIVE
One of the factors influencing the cost-effectiveness of population screening for Type 2 diabetes may be uptake. We examined attendance and practice- and individual-level factors influencing uptake at each stage of a diabetes screening programme in general practice.


METHODS
A stepwise screening programme was undertaken among 135, 825 people aged 40-69 years without known diabetes in 49 general practices in East England. The programme included a score based on routinely available data (age, sex, body mass index and prescribed medication) to identify those at high risk, who were offered random capillary blood glucose (RBG) and glycosylated haemoglobin tests. Those screening positive were offered fasting capillary blood glucose (FBG) and confirmatory oral glucose tolerance tests (OGTT).


RESULTS
There were 33 539 high-risk individuals invited for a RBG screening test; 24 654 (74%) attended. Ninety-four per cent attended the follow-up FBG test and 82% the diagnostic OGTT. Seventy per cent of individuals completed the screening programme. Practices with higher general practitioner staff complements and those located in more deprived areas had lower uptake for RBG and FBG tests. Male sex and a higher body mass index were associated with lower attendance for RBG testing. Older age, prescription of antihypertensive medication and a higher risk score were associated with higher attendance for FBG and RBG tests.


CONCLUSIONS
High attendance rates can be achieved by targeted stepwise screening of individuals assessed as high risk by data routinely available in general practice. Different strategies may be required to increase initial attendance, ensure completion of the screening programme, and reduce the risk that screening increases health inequalities.
Sargeant
L A
LA
MRC Epidemiology Unit, Cambridge, UK.
Simmons
R K
RK
Barling
R S
RS
Butler
R
R
Williams
K M
KM
Prevost
A T
AT
Kinmonth
A L
AL
Wareham
N J
NJ
Griffin
S J
SJ
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
D001786:Blood Glucose