Type 2 diabetes screening in community pharmacies could increase early diagnosis

Type 2 diabetes screening in community pharmacies could increase early diagnosis

Community pharmacies are well placed to screen patients for type 2 diabetes, which could increase early diagnosis and significantly reduce NHS costs—according to new research from the University of East Anglia and Boots UK.

More than three million people in the UK were diagnosed with diabetes in 2014 and there was an estimated 590,000 people with undiagnosed diabetes.

The estimated cost of type 2 diabetes to the NHS in 2011 was £8.8bn. The cost of diabetes to the NHS is expected to rise from 10 per cent to 17 per cent between then and 2035—with one third of this being due to complications of the disease.

Early identification and treatment of diabetes is known to reduce the incidence of complications. Screening services increase the number of diabetes diagnoses and results in cases being identified 3.3 years earlier on average.

The research team investigated the cost-effectiveness of community pharmacy based type 2 diabetes screening in two pilot areas—Leicester and Surrey. A total of 328 people took part in the study, and data was collected over a six month period on 2014.

They found that the cost per test and identification rates in patients were similar to those reported through medical practices for type 2 diabetes.

Efficiency of the screening service was also improved through the use of a risk screening tool questionnaire, which reduced the number of tests needed.

Researchers believe that locating a community pharmacy type 2 diabetes screening service in areas of suspected greater prevalence, and increasing the proportion of patients who follow pharmacist advice to attend their medical practice, would significantly improve the cost-effectiveness of the service.

Prof David Wright, from UEA’s School of Pharmacy, said: “This study shows that screening though community pharmacies is no more costly or less effective than undertaken through other routes. For such services to be cost-effective however, we also need to intervene in those identified as ‘high risk’ to prevent progression to diabetes.

“This is a natural addition to the diabetes screening process and, with appropriate funding, is something which community pharmacists can effectively do to contribute to the public health agenda.”

Marc Donovan, Chief Pharmacist at Boots UK, said: “This research highlights that there is a real opportunity for pharmacies in the UK to offer community based type 2 diabetes screenings and continue to support the services offered in GP practices.

“Not only does screening support patients by increasing early identification and treatment of type 2 diabetes, it is also known to reduce the incidence of complications, have a positive impact on costs to the NHS and, ultimately, supports the government’s public health agenda.”

‘Diabetes screening through community pharmacies in the UK: is it cost-effective’ is published in the journal Pharmacy.

 

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Testosterone therapy in hypogonadism can prevent progression to T2DM

(HealthDay)—Testosterone therapy (TTh) can prevent progression to type 2 diabetes (T2D) in men with prediabetes and hypogonadism, according to a study published online March 12 in Diabetes Care.

Aksam Yassin, M.D., Ph.D., from the Institute for Urology and Andrology in Norderstedt, Germany, and colleagues examined whether TTh in men with hypogonadism and prediabetes prevents progression to T2D. Data were included for 316 men with prediabetes and total testosterone levels ≤12.1 nmol/L combined with hypogonadism symptoms. Overall, 229 men received parenteral testosterone undecanoate (T-group) and 87 served as untreated controls. For eight years, metabolic and anthropometric parameters were measured twice yearly.

The researchers observed a decrease in hemoglobin A1c (HbA1c) by 0.39 ± 0.03 percent in the T-group and an increase of 0.63 ± 0.1 percent in the untreated group. Ninety percent of those in the T-group achieved normal glucose regulation (HbA1c 6.5 percent) occurred in 40.2 percent of those in the untreated group. Significant improvements were seen in fasting glucose, triglyceride: high-density lipoprotein (HDL) ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, low-density lipoprotein, HDL, non-HDL, triglycerides, and the Aging Males’ Symptoms scale in the T-group, while significant decreases were seen in these parameters in the untreated group.

“Testosterone treatment holds tremendous potential for the prevention of diabetes in the rapidly growing population of men with hypogonadism and prediabetes and warrants further investigation,” the authors write.

Several authors disclosed financial ties to Bayer, which funded the study.

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Researchers discover why people with Laron dwarfism don’t get diabetes

Reduced growth hormone receptor signalling improves insulin signalling within the body. 

University of Queensland researchers have discovered a hidden metabolic advantage that prevents people with a specific type of dwarfism from developing type 2 diabetes or cancer.

UQ Diamantina Institute researcher Dr. Yash Chhabra said the findings could pave the way for new diabetes treatments for all.

“We set out to understand why, unlike most people, people with Laron dwarfism don’t develop diabetes despite being obese,” Dr. Chhabra said.

“People with Laron dwarfism aren’t sensitive to growth hormone due to a defective growth hormone receptor in their cells.

“Growth hormone is responsible for regulating height, metabolism and obesity.

“Having defective receptors also means Laron dwarfs remain highly sensitive to insulin.”

Emeritus Professor Michael Waters said normally when a person became obese, their sensitivity to insulin decreased and they eventually developed type 2 diabetes.

“Our study clarifies an issue that has been unresolved for 50 years,” Professor Waters said.

“We discovered that a signalling molecule activated by the growth hormone receptors, called STAT5, was responsible for regulating this insulin sensitivity.

“Defective growth hormone receptors meant the STAT5 molecules weren’t activated properly.

“This switching off of the STAT5 activation improved prevented insulin resistance by improving insulin signalling.

“This increased insulin receptors and reduced glucose output from the liver.”

Dr. Chhabra said understanding how defective growth hormone receptors prevented diabetes at the cellular and tissue level could enable researchers to develop treatments for the general population.

“Both growth hormone receptors and STAT5 could become targets for new treatments,” he said.

The study was a collaboration between UQ, the University of Melbourne and Boston University and is published in The FASEB Journal.

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