Who Should be Screened? Using The Canadian Diabetes Risk Questionnaire (CANRISK)

Mr. AW qualifies for screening on a variety of levels:

• High risk based on risk calculator
• Individuals ≥ 40 should be screened every three years

In addition, Mr. AW has the following risk factors:

• Age ≥ 40
• First-degree relative with type 2 diabetes
• Member od high-risk population: Asian
• Overweight
• Abdominal obesity

These factors are used to calculate his CANRISK score. Further investigation would probably reveal additional risk factors.

What tests should be ordered to screen for diabetes?

FPG A1C FPG and A1C

CDA Guidelines suggest screening with a FPG and/or A1C. In this case, a FPG and A1C is ordered.

Screening tests for type 2 diabetes reveal the following results:

• FPG: 5.8 mmol/L
• A1C: 6.3%

What would be the next steps?

Repeat both tests (FPG and the A1C)
Repeat the “higher” test
Order a 75g OGTT

A 75g OGTT is ordered.

NOTE: Unlike the diagnosis of diabetes, when discordance between A1C and FPG values exist in the pre-diabetes range, there is no need to repeat the tests. In the case of pre-diabetes, use the test that appears furthest to the right side of the algorithm.

Results of 75g OGTT:

• Fasting value: 5.6 mmol/L
• 2hr value: 8.9 mmol/L

Diagnosis of Impaired Glucose Tolerance is confirmed.

Mr. AW is referred to Diabetes Education Teams where possible and/or offered information on the Prevention of Diabetes (see Prevention chapter of CPGs).

Mr. AW is monitored “more frequently” for the development of the diagnosis of diabetes.