Diabetes: Health Screening

Dr. TSUI Yee Ling, Elaine

Assistant Director, Department of Health Assessment

Co-Director, Endocrine and Diabetes Centre

Honorary Consultant in Endocrinology

Honorary Consultant in Internal Medicine

Specialist in Endocrinology, Diabetes and Metabolism

Diabetes is a major cause of morbidity and mortality in Hong Kong, According to a report from the Centre for Health Protection, diabetes was responsible for 1.2 % of all registered deaths in 2020, and is the tenth commonest cause of death in Hong Kong. Based on a population health survey from 2020 to 2022 conducted by the Department of Health, the prevalence of diabetes among persons aged 15 - 84 was 8.5 % (6.1 % for female and 11.1 % for males). The total prevalence of diabetes has also increased steadily with age, from 0.6 % among those aged 15 - 24 to 19 % among those aged 64 - 84.

Symptoms

People with diabetes are often asymptomatic, i.e. they can only be diagnosed by checking blood during health assessment. As the disease progresses, they may present with symptoms or complications such as  thirst, excessive urination, weight loss, infections, poor would healing, visual loss, kidney and heart problems or stroke. Uncontrolled diabetes can present acutely with dehydration or coma.

Screening and Early Detection

The purpose of diabetes screening is to identify asymptomatic individuals who are at risk of diabetes. Diabetes is often asymptomatic in its early stage, and can remain undetected for many years until complications develop. With early detection, intervention and treatment have been shown to prevent or delay disease progression and its complications

Based on the most recent guidelines from the American Diabetes Association, adults aged 18 or over should be screened for diabetes if they are overweight and or have other risk factors. Additionally, all adults at and over age 35 should screened for diabetes. If test results are normal, screening should be repeated at a minimum of 3 years’ intervals.

Who should be screened

1. Age 35 or above

2. Anyone with any of the following risk factors for diabetes:

- A family history (first-degree relatives) of diabetes

- Overweight (BMI > 23 for Chinese adults)

- Previous impaired glucose intolerance of impaired fasting glucose

- Central obesity ( waist circumference > 90 cm for Asian men; > 80 cm for Asian women)

- Hypertension

- Cardiovascular disease

- Other cardiovascular risk factors (e.g. hyperlipidemia, smoking, physical inactivity)

- Metabolic syndrome

- Women with a history of gestational diabetes or big baby (> 4 kg)

- Polycystic ovarian syndrome

- Long-term systemic steroid therapy

What test(s) should be done

Doctor may prescribe one or more of the following tests:

- Fasting plasma glucose ( not eating for at least 8 hours)

- Glycated haemoglobin (HbA1c)

- Oral glucose tolerance test (OGTT)：this test measures blood glucose levels before and after a standard drink containing glucose.

How often

- At least every 3 years

- More frequently (e.g. every 12 months) when risk factors are present.

Sources:

1. American Diabetes Association Standards of Care in Diabetes 2022

2. Hong Kong Reference Framework for Diabetes Care in Primary Care Settings, Revised Edition 2021

Prevention of Diabetes

Numerous studies have shown that adhering to a healthy lifestyle is associated with around 75% lower risk of developing diabetes. Please consult with your health care professionals for tailor-made health advice. Below are some of the general health tips:

1. Be physically active: adults are encouraged to have at least 150 minutes of moderately intense physical activity per week.

2. Eat a balanced diet containing at least 5 daily servings of fruit and vegetable. Also choose whole grain over refined grain, and limit fat, salt and sugar intake.

3. Avoid smoking.

4. Refrain from alcohol consumption.

5. Maintain a healthy body weight.