The RACGP Red Book recommends a risk-based approach to diabetes screening.
Risk Assessment: A risk assessment tool such as the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) can be used to identify people at high risk of developing type 2 diabetes. This tool takes into account factors such as age, sex, ethnicity, family history of diabetes, diet, physical activity, blood pressure, and waist circumference.
Who Should be Screened: The Red Book generally recommends using the AUSDRISK tool for all adults aged 40 to 49 years. It also suggests using the tool in people with cardiovascular disease or a history of gestational diabetes or in those who are overweight, particularly if they also have high blood pressure. For ATSI > 18 years, we proceed directly to HbA1c or OGTT or fasting BSL. We do not use AUSDRISK.
Frequency of Screening: For people who are at high risk of diabetes (as determined by a tool like AUSDRISK), the Red Book suggests considering an oral glucose tolerance test (OGTT) or HbA1c test. If the person is not diagnosed with diabetes, the test may be repeated every 1-3 years, depending on the person’s risk level.
High-Risk Groups: Some groups, such as people with certain conditions (polycystic ovary syndrome, antipsychotic medication usage or a family history of type 2 diabetes) may need more regular screening.
Diagnosis of Diabetes
- Fasting plasma glucose level ≥ 7.0 mmol/L
- 2-hour plasma glucose level ≥ 11.1 mmol/L during an oral glucose tolerance test
- HbA1c ≥ 6.5%
- Random plasma glucose ≥ 11.1mmol/L in a patient with classic symptoms
AUSDRISK
The AUSDRISK tool, which stands for the Australian Type 2 Diabetes Risk Assessment Tool, is a method used to assess the risk of developing type 2 diabetes in Australian adults over the next five years. This tool is particularly useful in a primary care setting and can help guide decisions regarding further testing and preventive strategies. It’s a questionnaire-based tool that evaluates various risk factors. Here’s a summary of its key components:
- Age Group: Age is a significant risk factor for type 2 diabetes. The AUSDRISK tool categorizes individuals into different age groups, with higher scores for older ages.
- Gender: Male or female, with males having a slightly higher risk.
- Ethnicity: Certain ethnic groups are at a higher risk of developing type 2 diabetes. The tool accounts for this factor.
- Family History of Diabetes: A family history of type 2 diabetes increases the risk.
- History of High Blood Glucose: Previous records of high blood sugar levels can be a predictor.
- Blood Pressure Medication: Being on medication for high blood pressure is a risk factor.
- Smoking Status: Current and former smokers are at higher risk compared to non-smokers.
- Dietary Factors: The tool assesses dietary habits, especially the consumption of fruits, vegetables, and wholegrain foods.
- Physical Activity Level: Physical inactivity is a significant risk factor for type 2 diabetes.
- Waist Measurement: Abdominal obesity is a strong predictor of diabetes risk. The tool uses different waist circumference measurements for men and women and for people of different ethnicities.
After completing the questionnaire, the total score categorizes the individual’s five-year risk of developing type 2 diabetes into one of several categories: low, moderate, high, or very high. This risk assessment can then guide healthcare professionals in recommending lifestyle changes, monitoring strategies, or further medical evaluation for individuals at higher risk.
It’s important to note that while tools like the AUSDRISK are useful for assessing risk, they cannot diagnose diabetes. High-risk scores should be followed up with a formal investigation.
ATSI
For ATSI we proceed directly to Fasting BSL, HbA1c, UEC, Alb/Cr and BP from age 18. We do not use AUSDRISK.