Original research| Volume 8, ISSUE 3, P224-230, October 2014

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Screening for type 2 diabetes and pre-diabetes in general practice: A descriptive study of Maltese practices

Published:January 21, 2014DOI:



      The aim of this research study was to ascertain the awareness of Maltese family doctors to the prevalence and significance of impaired glucose regulation and early diagnosis of type 2 diabetes and whether practices were influenced by employment status, post-graduate training in diabetes or years since graduation.


      A specially constructed questionnaire was distributed by mail to all the 298 family doctors listed as Specialists in Family Medicine in the Maltese Medical Council register. Participants had to be practising family medicine in Malta. Results were analysed using SPSS 20.0 aiming for a significance criterion of 0.05 and a power of 80%.


      Valid replies were received from 154 GPs (51.7%). 93.2% claimed to offer their patients some form of screening. Screening levels reached up to 95.9% in the presence of specific risk factors (e.g. high previous HbA1c levels) but fell to between 46.2% and 58.7% in patients over 50, the physically inactive and those who suffer from polycystic ovarian syndrome. Screening using capillary glucose is widespread (70.8%) as opposed to the oral glucose tolerance test (23.4%). Results also show a high use of urinalysis in screening (53.2%) and a paradoxical lack of use of HbA1c in screening by young doctors and by those with recent extra training in diabetes.


      The need for a structured screening programme in Malta and its viability need to be evaluated by further studies. Educational support to GPs together with logistic support for GPs needs to be improved.


      IDF (International Diabetes Federation), IFG (Impaired Fasting Glucose), IGT (impaired glucose tolerance), FCWB (fasting capillary whole blood), RCWB (random capillary whole blood), FVP (fasting venous plasma), RVP (random venous plasma), HbA1c (glycated haemoglobin), OGTT (oral glucose tolerance test)


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        • World Health Organization
        Screening for Type 2 Diabetes. Report of a World Health Organization and International Diabetes Federation Meeting.
        World Health Organization, Geneva, Switzerland2003
        • Shaw J.E.
        • Sicree R.A.
        • Zimmet P.Z.
        Global estimates of the prevalence of diabetes for 2010 and 2030.
        Diabetes Res. Clin. Pract. 2010; 87: 4-14
        • International Diabetes Federation
        IDF The Diabetes Atlas.
        6th ed. Atlas, Brussels2013
        • Directorate for Health Information and Research
        Department of Health, Ministry of Health, the Elderly and Community Care.
        The European Health Examination Survey Pilot Study, 2010
        • Eriksson K.
        • Lindgrade F.
        Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercises.
        Diabetologia. 1991; 34: 891-898
        • Pan X.
        • Li G.
        • Hu Y.
        • Wang J.
        • Yang W.
        • An Z.
        Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.
        Diabetes Care. 1997; 20: 537-544
        • Lindström J.
        • Louheranta A.
        • Mannelin M.
        • Rastas M.
        • Salminen V.
        • Eriksoon J.
        The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity.
        Diabetes Care. 2003; 26: 3230-3236
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.
        • Valle T.
        • Hamalainen H.
        • Ilanne-Parikka P.
        • Keinänen-Kiukaanniemi S.
        • Laakso M.
        • Louheranta A.
        • Rastas M.
        • Salminen V.
        • Uusitupa M.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Ramachandran A.
        • Snehalatha C.
        • Mary S.
        • Mukesh B.
        • Bhaskar A.
        • Vijay V.
        The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
        Diabetologia. 2006; 49: 289-297
        • Knowler W.
        • Barrett-Connor E.
        • Fowler S.E.
        • Hamman R.F.
        • Lachin J.M.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N. Engl. J. Med. 2002; 346: 393-403
      1. UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors.
        Diabetes Res. 1990; 13: 1-11
        • Spijkerman A.M.
        • Adriaanse M.C.
        • Dekker J.M.
        Diabetic patients detected by population-based stepwise screening already have a diabetic cardiovascular risk profile.
        Diabetes Care. 2002; 25: 1784-1789
        • Spijkerman A.M.
        • Dekker J.M.
        • Nijpels G.
        Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn Screening Study.
        Diabetes Care. 2003; 26: 2604-2608
        • Sandbaek A.
        • Griffin S.J.
        • Rutten G.
        Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study.
        Diabetologia. 2008; 51: 1127-1134
        • Del S.
        Prato Megatrials in type 2 diabetes. From excitement to frustration?.
        Diabetologia. 2009; 52: 1219-1226
      2. American diabetes association standards of medical care in diabetes – 2013.
        Diabetes Care. 2013; 36: S11-S66
        • Paulweber B.
        • Valensi P.
        • Lindström J.
        • Lalic N.M.
        • Greaves C.J.
        • McKee M.
        • Kissimova-Skarbek K.
        • Liatis S.
        • Cosson E.
        • Szendroedi J.
        • Sheppard K.E.
        • Charlesworth K.
        • Felton A.M.
        • Hall M.
        • Rissanen A.
        • Tuomilehto J.
        • Schwarz P.E.
        • Roden M.
        • for the Writing Group, on behalf of the IMAGE Study Group
        A European evidence-based guideline for the prevention of type 2 diabetes.
        Horm. Metab. Res. 2010; 42: S3-S36
        • National Institute for Health and Clinical Excellence
        Preventing Type 2 Diabetes: Risk Identification and Interventions for Individuals at High Risk.
        NICE Public Health Guidance 38, 2012
        • Diabetes UK
        Early Identification of People With Type 2 Diabetes. Position Statement, United Kingdom: Diabetes UK. Position Statement 2012.
        2012: 1-8 (Available from: (accessed 11.03.13))
        • Canadian Task Force on Preventive Health
        Recommendations on screening for type 2 diabetes in adults.
        CMAJ. 2012; 184: 15
        • Diabetes Australia Guideline Development Consortium
        National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes Prepared by: The Diabetes Unit Menzies Centre for Health Policy The University of Sydney for the: Diabetes Australia Guideline Development Consortium.
        2009 (Available from: (accessed 11.03.13))
        • Rydén L.
        • Standl E.
        • Bartnik M.
        • Van den Berghe G.
        • Betteridge J.
        • de Boer M.J.
        • Cosentino F.
        • Jonsson B.
        • Laakso M.
        • Malmberg K.
        • Priori S.
        • Ostergren J.
        • Tuomilehto J.
        • Thrainsdottir I.
        • Vanhorebeek I.
        • Stramba-Badiale M.
        • Lindgren P.
        • Qiao Q.
        • Priori S.G.
        • Blanc J.J.
        • Budaj A.
        • Camm J.
        • Dean V.
        • Deckers J.
        • Dickstein K.
        • Lekakis J.
        • McGregor K.
        • Metra M.
        • Morais J.
        • Osterspey A.
        • Tamargo J.
        • Zamorano J.L.
        • Deckers J.W.
        • Bertrand M.
        • Charbonnel B.
        • Erdmann E.
        • Ferrannini E.
        • Flyvbjerg A.
        • Gohlke H.
        • Juanatey J.R.
        • Graham I.
        • Monteiro P.F.
        • Parhofer K.
        • Pyorala K.
        • Raz I.
        • Schernthaner G.
        • Volpe M.D.
        Wood guidelines on diabetes, prediabetes, and cardiovascular diseases: executive summary: the task force on diabetes and cardiovascular diseases of the European society of cardiology (ESC) and of the European association for the study of diabetes (EASD).
        Eur. Heart J. 2007; 28: 88-136
        • Alberti K.G.M.M.
        • Zimmet P.
        • Shaw J.
        International diabetes federation: a consensus on type 2 diabetes prevention.
        Diabetic Med. 2007; 24: 451-463
        • Soler J.K.
        • Yaman H.
        • Esteva M.
        • Dobbs F.
        • Asenova R.S.
        • Katic M.
        • Ozvacic Z.
        • Desgranges J.P.
        • Moreau A.
        • Lionis C.
        • Kotanyi P.
        • Carelli F.
        • Nowak P.R.
        • de Aguiar Sa Azeredo Z.
        • Marklund E.
        • Churchill D.
        • Ungan M.
        • European General Practice Research Network Burnout Study Group
        Burnout in European family doctors: the EGPRN study.
        Fam. Pract. 2008; : 245-265
        • Sciortino P.
        A Service Profile of Maltese General Practitioners. A Provider Survey of the General Practice Component of the Maltese Health Care System.
        Department of Public Health, Medical School, University of Malta, Malta2002 (MSc Dissertation)
        • Ovalle F.
        • Azziz R.
        Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus.
        Fertil. Steril. 2002; 77: 1095-1105
        • Gambineri A.
        • Patton L.
        • Altieri P.
        • Pagotto U.
        • Pizzi C.
        • Manzoli L.
        • Pasquali R.
        Ploycystic ovary syndrome is a risk factor for type 2 diabetes. Results from a long-term prospective study.
        Diabetes. 2012; 61 (accessed 24.03.13): 2369-2374
        • Dunstan D.W.
        • Salmon J.
        • Owen N.
        • Armstrong T.
        • Zimmet P.Z.
        • Welborn T.A.
        • et al.
        • on behalf of the AusDiab Steering Committee
        Physical activity and television viewing in relation to risk of ‘undiagnosed’ abnormal glucose metabolism in adults.
        Diabetes Care. 2004; 27: 2603-2609
        • Hu F.B.
        • Li T.Y.
        • Colditz G.A.
        • Willett W.C.
        • Manson J.E.
        Television watching and other sendentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women.
        J. Am. Med. Assoc. 2003; 289: 1785-1791
        • Englelgau M.M.
        • Narayan V.K.M.
        • Herman W.H.
        Screening for type 2 diabetes.
        Diabetes Care. 2000; 23: 1563-1580
        • Ritchie G.E.
        • Kenge A.P.
        • Joshi R.
        • Chaw C.
        • Neal B.
        • Patel A.
        • Zoungas S.
        Comparison of near-patient capillary glucose measurement and a risk assessment questionnaire in screening for type 2 diabetes in a high-risk population in rural India.
        Diabetes Care. 2011; 34: 44-49
        • Marley J.V.
        • Davis S.
        • Coleman K.
        • Hayhow B.D.
        • Brennan G.
        • Mein J.K.
        • Nelson C.
        • Atkinson D.
        • Maguire G.P.
        Point-of-care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia.
        Med. J. Aust. 2007; 186: 500-503
        • Rush E.
        • Crook N.
        • Simmons D.
        Point-of care testing as a tool for screening for diabetes and pre-diabetes.
        Diabetic Med. 2008; 25: 1070-1075
        • Simmons R.K.
        • Echouffo-Tcheugui J.B.
        • Sharp S.J.
        • Sargeant L.A.
        • Williams K.A.
        • Toby Prevost A.
        • Kinmonth A.L.
        • Wareham N.J.
        • Griffin S.J.
        Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial.
        Lancet. 2012; 380: 1741-1748
        • Rahman M.
        • Simmons R.K.
        • Hennings S.H.
        • Wareham N.J.
        • Griffin S.J.
        Effect of screening for type 2 diabetes on population-level self-rate health outcomes and measures of cardiovascular risk: 13 year follow-up of the Ely cohort.
        Diabetic Med. 2012; 29: 886-892