Objective
For early detection of persons at risk for type 2 diabetes, a combination of risk factor assessment and glucose measurement
could be a promising approach and an opportunity for health promotion. The object of this study was to develop a sequential
screening concept and to evaluate it in a national pharmacy based screening campaign.
Method
Community pharmacies of the German speaking part of Switzerland participating in the national Self Care campaign “Stop diabetes-test
now” offered a free of charge “sequential screening” with (a) diabetes risk assessment, (b) consecutive capillary blood glucose
measurement and (c) assessment of the motivation for lifestyle change based on the Transtheoretical Model (TTM) of behaviour
change. A 35 items data sheet served as a structured screening protocol and enabled quick and reliable documentation of all
relevant data. Outcomes measures were: age, sex, cigarette smoking, total score of the ADA diabetes risk-factor questionnaire,
family history of diabetes, body mass index, insufficient physical activity, blood pressure, capillary blood glucose, motivation
for lifestyle change, counselling activities and triage decisions of the pharmacy team.
Results
During the 5 weeks of spring 2002, 530 pharmacies screened a total of 93,258 persons (33.1% male, mean age 60.9 years ± 14.1
(SD)). Risk profile: family history of diabetes 26.4%; BMI ≥ 25 kg/m
2 49.3%; low physical activity 27.2%; elevated blood pressure 45.7%. Stratification into risk groups: < 2 risk factors 21.6%;
≥ 2 risk factors 71.5%; borderline glycaemia (FG 5.3–6.1 mmol/l, confirmed in a second measurement) 2.5% and hyperglycaemia
(FG ≥ 6.1 mmol/1 or NFG ≥ 11.1 mmol/1) 4.4%.
Of all persons screened, 6.4% were referred to a physician and 73.7% got targeted advice with respect to physical activity
and/or nutrition based on their specific risk profile.
Conclusion
The screening campaign attracted an important part of Swiss German speaking adults (2.4%). The sequential screening could
successfully be implemented into pharmacy practice. Of the generally elderly persons screened, 6.9% were detected with suspicion
for diabetes type 2 and 71.5% had at least two risk factors. This provided an opportunity to initiate targeted counselling
regarding therapeutic lifestyle change.
Keywords Blood glucose measurement - Community pharmacy - Diabetes risk score - Diabetes screening - Evaluation - Pharmacy practice - Risk assessment - Screening campaign - Switzerland - Triage