Screening and Diabetes Type II

Becky Ellis, RN, BSN

Screening

The process of detecting unrecognized disease in otherwise

healthy populations

4 Types of Screening

Mass Screening

Applied to entire populations

– 1981 screening for elevated blood lead levels all adults within state– 1970 screening for cervical cancer

on women admitted to hospitals within state– PKU testing on all newborns

Selective Screening

• Targets specific high-risk populations

−Mammograms recommended more frequently for women with a family history of breast cancer

− PPD for hospital personnel

Multiphasic Screening

• A variety of screening tests applied to the same population on the same

occasion

− Includes a series of tests on a single vial of blood

– Pre-op work-ups, periodic health assessment and for monitoring the stage of an illness.

Case-Finding Screening

• A Search for illness done during an individuals periodic health assessment

− Pap Smears and Breast Exams for women− Testicular Examinations for men− The Denver Developmental Screening

Test

Appropriateness of Screening

• Health problem with serious consequences e.g. Diabetes

• Must be cost effective or have positive health outcomes• PAP Smears result in possible cure• PKU Screening can prevent mental

retardation

To be Beneficial

• Screening should result in a better prognosis

• The screening process should be effective in reducing morbidity and mortality

• The prevalence of the health problem is high in the population

• Should be quick, easy and noninvasive when possible

The Health Problem:

• Have a high prevalence in the population

• Be relatively serious• Be able to be detected in early stages• Have an effective treatment that

improves outcomes

The Screened Group:

• Be identifiable• Be assessable• Accept the screening procedures• Be willing to seek treatment• Accept follow-up procedures

The Screening Test:

• Cost effective• Simple, safe, and easy to administer• Of minimal discomfort• Sensitive enough to detect most cases• Specific to the health problem• Valid and reliable

Sensitivity and Specificity

• Sensitivity• Populations who have the health problem

are correctly identified

• Specificity • Populations who do not have the health

problem are correctly identified

Predictive Value

• Frequency with which the health problem is correctly identified among those screened

Yield

• Previously unrecognized cases of the disease that is identified during the screening process

CDC October 2003

Newly Diagnosed Cases of Diabetes by Year

• Steady Increase since 1997

Screening Tests Type II Diabetes

• Fasting Plasma Glucose (FPG)• Two Hour post-load plasma

glucose (2 hour GTT)• Glycosylated hemoglobin A1c

(HbA1c)

ADA Recommendations for Screening

• Fasting Plasma Glucose (FPG)• Faster to perform• More convenient • Acceptable to patients• Less expensive

Other ADA Recommendations for

Diabetes Screening• Selective Screening based on risk

factors• Age>45• BMI>25• Family History • Habitual physical inactivity• Race/Ethnicity e.g. African Americans,

Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders

• Previously identified impaired fasting glucose or impaired glucose tolerance

Selective Screening

• Recommended that Clinicians use the ADA’s guidelines for selective screening of at-risk individuals

Nursing Implications: Diabetes Type 2

Tori L. Reid, RN BSN

Learning From Listening: The Article

• Qualitative research from CDC, taped interviews, themes

• 235 Participants, 2002• Screened to have risk factors• Formal and informal community

leaders invited by recommendations

Five Themes

• Attributions for Diabetes: “American lifestyle”, “don’t sweat”, biological risk factors, stress, poor eating habits, lack of physical exercise

• Reactions to findings confirming benefits of lifestyle interventions for diabetes prevention: encouraging and hopeful, common sense, modest recommendations, but wont be easy

Five Themes Continued

• Awareness of the potential for preventing or delaying diabetes as a motivator for action: realistic fear can play a role, rewards must be connected to meaning, social support is critical, consistency with cultural or historical values, children need to be taught healthy lifestyles early

Five Themes Continued

• Barriers to change: lack of time, fast food and sedentary entertainment, high cost of nutritional food, lack of family support, environmental constraints, lack of awareness about diabetes, diabetes not a priority in some communities

Five Themes Continued

• How people want to be told if they have prediabetes: straightforward but with gentle, hopeful approach, simple explanations, knowing can be empowering, tied to hope

What Can We Do?

• Social Support• Message design: use staging

and visual teaching tools• Gain exposure and attention:

“turn up the volume”• Identifying message appeal:

hope dispels fatalism

What Can We Do?

• Accordance with values, belief and history: memories matter

Historic/Current Approaches• Screenings: clinics, physician’s

office, work, mall, social groups• Follow-up: • Education: public, hospital,

physician’s office, formal education programs, internet,

• FOCUS ON SECONDARY/TERTIARY

Current/Future Approaches• Division of Diabetes Translation (DDT):

“charged with developing and implementing a public health response to the rising burden of diabetes in the United States”

• Goal: “reduce the burden of diabetes through collaborations with diabetes prevention and control programs (DPCP)”

Current/Future Approaches• Plans: strengthen public health

surveillance systems for diabetes, conduct applied translational research, implement the National Diabetes Control Program, implement the National Diabetes Education Program, and coordinate media strategies and provide public information

Discussion

• What have you seen?• What are you doing?• Where can we improve?• Community programs in place

now?

ReferencesJack, L; Narayan, K; Satterfield, D; Lanza, A. Public health

approaches in diabetes prevention and control, Journal of Public Health Management and Practice; Nov 2003; Proquest Medical Library pg. S5.

Satterfield, D; Lofton, T; May, J; Bowman, B; et al. Learning from listening: Common concerns and perceptions about diabetes prevention among diverse american populations. Journal of Public Health Management and Practice; Nov 2003; Proquest Medical Library pg. S56

Harkness, Gail A.; Epidemiology in Nursing Practice, Mosby Inc, 1995.

Zhang, P; Engelgau, M. M.; Valdez, R.; Benjamin, S.; Caldwell, B.; Venkat Narayan, K. M.; Costs of Screening for Pre-diabetes Among U.S. Adults, Diabetes Care; September 2003.

Screening for Type 2 Diabetes, Diabetic Care, January 2003