Earlier today I posted a message saying we had a fantastic 33/133 responses to our invitation to undergo a drop in / point of care HbA1c blood test this morning, for those with a 15% QDiabetes risk. By the close of play (we had to stay open an extra 1/2hr) and had performed 63 tests, a massive 48% response to a single invitation letter.
Of these we found one diabetic (HbA1c 65) and 5 with borderline results/IGT (HbA1c 42-47 and BS 7-9.9) enrolled 9 into our E4H lifestyle sessions, and agreed lifestyle changes with many of the others.
Here are some instructions for patients who turn up at the pre-diabetes screening day event
And the general instructions for clinical staff (1 receptionist, two nurses, two doctors and 3 Infinion PoC HbA1c machines)
EmisWEB template we used
Pre-DM Screening template
Today we are running our drop in screening clinic at Falkland Surgery. So far the morning rush has seen a fantastic response of 33 attendees from an invitation letter to 133 patients (10.15am so far). Still working through the tests and luckily no diabetics identified so far.
We have now picked up 5 new diabetics out of 19 respondents, so virtually 25% positive identifications of diabetes with the same number of borderline results. This is higher than the 14% we got in the first cohort (though probably random variation)
One participating surgery has just reported that although only 9 out of 50 people responded to our invite (for those over 30% QDiabetes risk) of those 9 patients, 2 have been shown to have undiagnosed Diabetes, and 4 have borderline HbA1c between 42 and 47. Thats a 22% pickup rate. How do we catch the non responders?
So far we are averaging about 14% pickup rate for those responders
I have uploaded a new alert protocol that pops up if a patient consults with a raised QDIabetes score, who hasn’t had some sort of advice or screening logged in the last year (Glucose, HbA1c, or “Lifestyle advice about the risk of Diabetes”)
Download it, unzip and load it up into your templates and protocol folder.
Qdiabetes alert protocol
Today we started the third thread of the Project, inviting patients with > 15% 10 yr risk of Diabetes via QDiabetes to have screening. As a trial in one practice (my own, Falkland Surgery) we have today written to the 266 patients with a QDIabetes score of 15% and above, offering them one of two screening options.
Group 1 will get a letter inviting then to a drop in clinic next Saturday where we will offer them an on-the-spot HbA1c and random blood sugar test and advice including enrollment in our Eat4Health sessions.
Group 2 will get a similar letter but inviting them to get a routine HbA1c and Glucose blood test performed by phlebotomy in the usual way.
Although not statistically significant in size we hope to compare the costs and response rates of the two groups to guide us when we repeat this across the patch (potentially inviting about 1500 patients for screening).
Based on our Newbury Show Screening where we tested 111 patients with risks above 15% and picked up 5 Diabetic HbA1c levels, and another 5 borderline results, we might expect a similar pickup rate. Depending on the response rate to the letters we could potentially identify 12-15 new Diabetics, and the same number of borderline (IGT) results in this process.
Initial results for the first arm (The drop in clinic) will be posted next weekend
The second cohort of patients has now completed their Eat4Health course. They acheived a fantastic 4.5kg average weight loss, or the equvalent of 5% of their 96Kg starting weight through the course of the sessions. Congratulations, that is a massive effort.