The impact of population-level HbA1c screening on reducing diabetes diagnostic delay in middle-aged adults: a UK Biobank analysis
Katherine Young, Andrew McGovern, Inês Barroso, Andrew T. Hattersley, Angus G. Jones, Beverley M. Shields, Nicholas J. Thomas, John Dennis
Abstract
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 HbA 1c -based screening in middle-aged adults. Methods We studied UK Biobank participants aged 40–70 years with HbA 1c 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 HbA 1c 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 HbA 1c 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 HbA 1c levels at UK Biobank enrolment, with a median HbA 1c 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 HbA 1c at clinical diagnosis of 58.2 mmol/mol (IQR 51.0–80.0) (7.5% [6.8–9.5]). Female participants with lower HbA 1c and BMI measurements at enrolment experienced the longest delay to clinical diagnosis. Conclusions/interpretation Our population-based study shows that HbA 1c 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 HbA 1c screening to reduce the time for which individuals are living with undiagnosed diabetes. Graphical abstract