Screening for diabetes in optometric practice

Abstract

Diabetes is an increasing problem worldwide and is placing increasing strain on the healthcare system. It often goes undiagnosed for many years until complications occur. Identifying undiagnosed disease presents a challenge to all healthcare professionals. In the UK, screening has traditionally been the role of general practitioners, although other professionals such as pharmacists have recently become involved. Optometrists may also be in a good position to carry out screening tests themselves. Their role in screening for diabetes has not been previously investigated.

The first part of the thesis takes a qualitative approach to explore optometrists’ perceptions, attitudes and beliefs about diabetes and screening for the disease. It demonstrated that if certain barriers, such as cost and training, can be overcome, some optometrists are willing to carry out screening tests. It also raises issues regarding their professional roles and their relationship with other healthcare providers.

The second part of the thesis describes the development and implementation of a screening scheme using random capillary blood glucose (rCBG) tests. Over three-quarters of eligible adults participated in the screening. We found that around one third (318) of those had a rCBG level requiring further investigation. Half of these people reported attending their GP and receiving further investigation. 16 (5%) were subsequently diagnosed with either diabetes or pre-diabetes. Those who participated in the screening programme found the test procedure to be comfortable, convenient and would recommend it to others.

Analyses of strategies to identify those most at risk who would benefit from screening suggest that offering rCBG tests to those who are aged over 40 years with either a BMI of 25kg/m2 or more, or a family history of diabetes or both, would be effective for detection purposes.

This research confirmed the feasibility of testing for diabetes in optometry practices and opens the door for another, PCT-based, study. This novel approach has never been tried before.