Approximately 3.5m people are currently diagnosed with type 2 diabetes, but it is estimated that a further 549,000 remain undiagnosed. Type 2 diabetes is a chronic illness where the pancreas produces insufficient insulin to meet the body’s needs. This causes high blood sugar levels which damage the body and lead to complications such as vascular damage, vision loss and kidney disease, costing the NHS over £8.8bn each year.
Screening for diabetes can result in cases being identified on average 3.3 years earlier. Early detection gives both patients and staff an advantage in preventing complications.
A recent study by UEA and Boots UK looked at the cost effectiveness of using community pharmacists to screen members of the public for Type 2 diabetes. Participants first completed a questionnaire to assess their risk of developing the disease, and then those with moderate to high risk went on to receive a blood test called Hba1c. This test looks at average blood sugar levels over the last three months. Those with high results were asked to visit their GP for formal diagnosis.
The study found that the cost of the tests and referrals to GP were similar to that of testing and diagnosis solely through GP practice. However the study concluded that better cost-effectiveness is possible if the service takes place in areas of greater need and rates of self-referral to GP practice after a positive test result are improved.
Furthermore this study used a very focused view on costs and did not have the capacity to consider a wider costs approach, considering potential savings elsewhere.
For example a recent audit undertaken by two UEA medical students, Sukontee Pringsulaka and Jacob Smith, found that in a Norfolk GP practice just 37 percent of patients with a diagnosis of Type 2 diabetes received the appropriate monitoring tests as per the NICE guidelines.
Whilst this is likely due to a number of factors it could be due to overworked and under resourced GPs. By reducing the responsibility of GPs to screen it would allow them more time to focus on their already diagnosed patients, resulting in cost savings down the line due to improved disease management.
Access to community screening could also improve patient uptake as suggested by Cara-Megan who was diagnosed with type 2 diabetes aged 19. ‘I think more people would get diagnosed if a pharmacist could do it, it would be more accessible as getting a doctor’s appointment is a pain!’
This study by UEA could present the beginning of screening services for type two diabetes moving almost entirely to the community, allowing for a more accessible and efficient service.