Screening for Type 2 Diabetes Mellitus in Primary Care

Abstract

Introduction:Type 2 Diabetes mellitus today must beconsidered a public health problem in Costa Rica, since ithas a great impact in the quality of life of the patients andtheir families, due to its chronic complications and also inthe Social Security System due to its costs. Early diagnosisand prompt treatment decrease the burden of its complica-tions.Therefore, Diabetes screening in a high risk popu-lation should be considered beneficial. The purpose of thisstudy was to evaluate the results of a screening interventionin primary care in high risk persons.

Methodology:Screening was implemented along the year2000 in the adult population with at least one risk factor of 6 Primary Health Centers, incorporated in the daily routineof the primary health care attention. Four different strate-gies were used: the ""opportunistic"" during the regular med-ical consultation, a selective one during home visits, pro-grammed, directed to captive groups or social organiza-tions, and ""Jornadas"" during community or national healthfairs.

Results:During the year 2000, 173 new diabetic patientswere registered by the health centers, either they werenewly diagnosed or where known diabetics that lived in thearea, but were not following control there. The predomi-nant strategy was the ""oportunístic"", relaying the responsi-bility especially upon the physician. The programed strat-egy in ""Jornadas"" was undertaken during Health Fairs ofthe Primary care centers and during the World DiabetesDay, the 14 of November. The selective strategy was notperform systematically since there were no glucometers forthe primary health care assistant that does home visits. Theproper registration or ""coverage"" of the diabetic patients ofthe Health Center Area increased from 50% in1999 to70.2% in 2000, considering the former as the percentage ofdiabetic patients under control or registered divided by thenumber of diabetics accounted for each health center, con-sidering a prevalence of 5% of the population 20 years andolder.

Conclusion:Costa Rica can accomplish an early detectionand prompt treatment of Diabetes mellitus type 2 by screen-ing intervention of high risk individuals. This is alreadybeing done with through the ""opportunistic"" strategy. Thisstudy shows that this strategy can be effectively implement-ed and that it can be operational with little effort. Our HealthCare System, based in a primary health care setting, is inposition to develop other screening strategies that could givehigher coverage with lower costs: such as home visit screen-ing by the primary health assistant. Logistically the condi-tions are given, however this intervention requires a commu-nity study to determine its real cost-benefit. If the resultswere favorable, such intervention could be implemented aspart of diabetes care in the whole country, making CostaRica a pioneer in the world in this kind of intervention.