Category Archives: Meetings

Amazing 50% response rate from QDiabetes invitation/drop in clinic

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.

Pre Diabetes Screening day

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.

30% QDiabetes risk = 22% pickup rate for DM in one surgery

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

Trial of screening invitation for patients over 15% QDiabetes risk

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

Distribution of QDiabetes Results in a random GP practice


We looked at the distribution of QDiabetes scores in an urban practice of 14500 in semi-rural Berkshire, so an area of mainly white/caucasian patients and found this distribution.  Clearly a higher incidence of higher scores in men, and mainly in the 50-60yr old age group

We are shortly going to target those with a higher risk score for focussed screening.

 QDScore > 20% Female   0 0 0 0 11 26 51 6 0 0 0
  Male   0 0 1 2 16 40 70 9 0 0 0
QDScore > 30% Female   0 0 0 0 1 11 19 2 0 0 0
  Male   0 0 0 1 4 16 23 5 0 0 0
QDScore > 40% Female   0 0 0 0 0 4 1 0 0 0 0
  Male   0 0 0 1 2 5 3 0 0 0 0
QDScore > 50% Female   0 0 0 0 0 1 0 0 0 0 0
  Male   0 0 0 0 1 1 2 0 0 0 0

PreDM Project on tour!!!

I’m currently stopped over at Nottingham on my way to the RCGP Conference tomorrow in Harrogate for a Poster Presentation, then back down for Friday at the Emis NUG Conference and a lunchtime presentation there.

Come and see me at either (or both) conference!

Newbury Show Pre-diabetes Project Results

A few days on and I have the final results from our Newbury Show stand.

We performed

310 QDiabetes assessments and risk counselling conversations.

111 HbA1c point of care tests on those with a QDiabetes Risk of 10% or more.

80 Body Composition Analyses as part of healthy lifestyle discussions.

We provisionally diagnosed 5 people as diabetic who were not previously diagnosed.

There were 8 people with HbA1c 42-47 (at risk of DM) who were advised to get further assessment.

We have subsequently booked 30 people into the Eat4Health Sessions as a result of the stand


Notes.  Many of the QDiabetes calculations were prompted by people requesting them (particularly at busy times) though we did invite passer-by people to be tested (and we recognise a slight bias to inviting those people who might have a higher BMI!)

The threshold for offering HbA1c was set at 20% QDiabetes risk on Saturday, (plus clinically driven exceptions) but having assessed the day one data we revised our threshold down to 10% risk on the second day.  This was based on the experience of identifying someone with DM with a risk of 16% on day one.  Overall there is a balance to be struck between cost, workload and pickup rate, but informally we would suggest a 15% QDiabetes risk would have caught all of the “hidden” diabetics in our small cohort.

There was a fairly “generous” approach to applying the rules, with clinicians asking for HbA1c according to their judgement at times.

Some people slipped through the net and only told us they were diabetic after QDiabetes assessment (!) but gratifyingly their risks were generally over 30%.  Similarly we tested a couple of people with very low apparent QDiabetes scores, due to symptoms, BMI or suspicions.

In our overall small sample there was a small bias of risk score to be higher in the male subjects.  There appears to be an overall trend of higher HbA1c results in those tested, correlating to the QDiabetes risk score.

Risk vs score graph