”If patients with diabetes type 2 can be found and treated early, their risk for complications decreases substantially.”
Is it possible in primary care to find and treat people with diabetes? Can development of complications be prevented? These are questions asked in a large multi-center study with 3 000 patients. But this time it is not the patients that are the focus, it is their doctors.
“We want to see how best to screen for diabetes type 2 in primary care and how much there is to gain from this screening and subsequent intensive treatment, says Dr Annelli Sandbaeck who is the coordinator of the ADDITION-study.”
This study is not so much a classical medical study, looking at the outcomes of various pharmaceutical drugs, but one that focuses on the education and support for care givers.
“There are barriers to giving medicines to a patient without symptoms and who is apparently healthy but our strategy implies treating patients with pharmaceutical substances and often more than one.”
The patients have been enrolled in the study by a stepwise screening procedure. Patients at risk of developing diabetes were initially identified with the help of a questionnaire. In a second step, these patients had their blood glucose measured. Approximately half of them had results that were abnormally high and were given additional tests. Again approximately half of the patients had excessively high results and they were identified as pre-diabetic or diabetic and were included in the study.
“If these patients can be found and treated early in the disease process their risk of coronary disease, kidney problems or needing amputations decreases substantially.”
”Glucose strip meters should not be used for diagnosis. These meters are intended for monitoring of blood glucose levels in patients already diagnosed with diabetes.”
The principal purpose of the study is to determine if primary care staff, who are not specifically trained to care for diabetes patients, can successfully diagnose these patients. Since not all clinics use the WHO criteria for diagnosis, the limits used for diagnosis are often too high. As a result, patients in the early stage of the disease may be missed.
Another factor is that the staff sometimes do not trust the accuracy of the glucose meter and therefore are reluctant to use it for diagnosis. As a result, patients who could benefit from early intervention may not be recognized. A glucose analyzer to be used for diagnosis of diabetes or prediabetic conditions has to be very accurate. Therefore, all participating care units were equipped with a HemoCue® Glucose Analyzer at the start of the study to be able to perform the glucose analyses at the pointof- care. This instrument was chosen because according to Dr Annelli Sandbaeck, it was found to be the best suited instrument for the purpose.
“The HemoCue® Analyzer can be trusted to give exact measurements time after time and it is very simple to use. This is why we chose the HemoCue® Analyzer for this study. Glucose strip meters should not be used for diagnosis. These meters are intended for monitoring of blood glucose levels in patients already diagnosed with diabetes.”
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