The impact of population-level HbA1c screening on reducing diabetes diagnostic delay in middle-aged adults: a UK Biobank analysis
dc.contributor.author | Young, KG | |
dc.contributor.author | McGovern, AP | |
dc.contributor.author | Barroso, I | |
dc.contributor.author | Hattersley, AT | |
dc.contributor.author | Jones, AG | |
dc.contributor.author | Shields, BM | |
dc.contributor.author | Thomas, NJ | |
dc.contributor.author | Dennis, JM | |
dc.date.accessioned | 2022-11-22T10:57:15Z | |
dc.date.issued | 2022-11-22 | |
dc.date.updated | 2022-11-22T09:15:50Z | |
dc.description.abstract | Aims/hypothesis Screening programmes can detect cases of undiagnosed diabetes earlier than symptomatic or incidental diagnosis. However, the improvement in time to diagnosis achieved by screening programmes compared with routine clinical care is unclear. We aimed to use the UK Biobank population-based study to provide the first population-based estimate of the reduction in time to diabetes diagnosis that could be achieved by HbA1c-based screening in middle-aged adults. Methods We studied UK Biobank participants aged 40–70 years with HbA1c measured at enrolment (but not fed back to participants/clinicians) and linked primary and secondary healthcare data (n=179,923) and identified those with a pre-existing diabetes diagnosis (n=13,077, 7.3%). Among the remaining participants (n=166,846) without a diabetes diagnosis, we used an elevated enrolment HbA1c level (≥48 mmol/mol [≥6.5%]) to identify those with undiagnosed diabetes. For this group, we used Kaplan–Meier analysis to assess the time between enrolment HbA1c measurement and subsequent clinical diabetes diagnosis up to 10 years, and Cox regression to identify clinical factors associated with delayed diabetes diagnosis. Results In total, 1.0% (1703/166,846) of participants without a diabetes diagnosis had undiagnosed diabetes based on calibrated HbA1c levels at UK Biobank enrolment, with a median HbA1c level of 51.3 mmol/mol (IQR 49.1–57.2) (6.8% [6.6–7.4]). These participants represented an additional 13.0% of diabetes cases in the study population relative to the 13,077 participants with a diabetes diagnosis. The median time to clinical diagnosis for those with undiagnosed diabetes was 2.2 years, with a median HbA1c at clinical diagnosis of 58.2 mmol/mol (IQR 51.0–80.0) (7.5% [6.8–9.5]). Female participants with lower HbA1c and BMI measurements at enrolment experienced the longest delay to clinical diagnosis. Conclusions/interpretation Our population-based study shows that HbA1c screening in adults aged 40–70 years can reduce the time to diabetes diagnosis by a median of 2.2 years compared with routine clinical care. The findings support the use of HbA1c screening to reduce the time for which individuals are living with undiagnosed diabetes. | en_GB |
dc.description.sponsorship | Research England | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.description.sponsorship | Wellcome Trust | en_GB |
dc.identifier.citation | Published online 22 November 2022 | en_GB |
dc.identifier.doi | https://doi.org/10.1007/s00125-022-05824-0 | |
dc.identifier.grantnumber | CS-2015-15-018 | en_GB |
dc.identifier.grantnumber | 220601/Z/20/Z | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/131826 | |
dc.identifier | ORCID: 0000-0003-2570-3864 (Young, Katherine G) | |
dc.identifier | ORCID: 0000-0002-6833-9399 (McGovern, Andrew P) | |
dc.identifier | ORCID: 0000-0001-5620-473X (Hattersley, Andrew T) | |
dc.identifier | ORCID: 0000-0002-0883-7599 (Jones, Angus G) | |
dc.identifier | ScopusID: 7407101887 (Jones, Angus G) | |
dc.identifier | ORCID: 0000-0003-3785-327X (Shields, Beverley M) | |
dc.identifier | ORCID: 0000-0002-7171-732X (Dennis, John M) | |
dc.language.iso | en | en_GB |
dc.publisher | Springer | en_GB |
dc.rights | © The Author(s) 2022. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. | en_GB |
dc.subject | Diabetes | en_GB |
dc.subject | HbA1c | en_GB |
dc.subject | Public health | en_GB |
dc.subject | Screening | en_GB |
dc.subject | UK Biobank | en_GB |
dc.title | The impact of population-level HbA1c screening on reducing diabetes diagnostic delay in middle-aged adults: a UK Biobank analysis | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2022-11-22T10:57:15Z | |
dc.identifier.issn | 0012-186X | |
dc.description | This is the final version. Available on open access from Springer via the DOI in this record | en_GB |
dc.description | Data availability: UK Biobank data are available through a procedure described at http://www.ukbiobank.ac.uk/using-the-resource/ | en_GB |
dc.identifier.eissn | 1432-0428 | |
dc.identifier.journal | Diabetologia | en_GB |
dc.relation.ispartof | Diabetologia | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2022-09-14 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2022-11-22 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2022-11-22T10:54:36Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2022-11-22T10:57:16Z | |
refterms.panel | A | en_GB |
refterms.dateFirstOnline | 2022-11-22 |
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