Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in Western Nigeria: Implication for diabetes prevention

Abstract

Background: Prediabetes in primary care patients is often unrecognised, with a resultant loss of opportunity for diabetes prevention. A paucity of information about the magnitude of missed opportunities for prediabetes screening in Nigeria and other African countries exists.

Methods: A cross-sectional study was conducted amongst 417 primary care participants aged ≥ 18 years. A questionnaire was administered and respondents were assessed for a missed opportunity for prediabetes screening using seven risk factors identified from guidelines. The fasting blood glucose (FBG) test was performed with capillary blood using a glucometer (Accucheck Advantage, Roche Diagnostics, Mannheim, Germany). Prediabetes was defined as an FBG of 5.6 mmol/L – 6.9 mmol/L according to the American Diabetes Association (ADA) guidelines.

Results: The incidences of missed prediabetes and diabetes diagnoses were 8.8% and 1.0%, respectively. The proportion of respondents who had various risk factors that met screening guidelines but missed the opportunities for prediabetes screening was between 2.2% and 44.1%. Approximately 80% of the respondents had at least one of the seven guideline-recommended risk factors but were not screened by the clinic doctors. The higher the number of risk factors in the respondents, the higher the proportion of respondents with a missed prediabetes diagnosis.

Conclusion: There were missed opportunities for prediabetes screening and consequent diabetes prevention identified in this study. The finding that high-risk patients with prediabetes in our setting often missed the opportunity to be detected through screening suggests that primary care physicians in our setting need to improve on the practice of prediabetes screening.

Keywords: prediabetes; diabetes; missed opportunity; missed diagnosis; primary care; primary care physicians; family practice clinic.