Screening should be considered in adults of any age who have one or more risk factors for DM. In those without risk factors, testing should begin at 40 years old. Those between 18-39 years old can consider doing the Diabetes Risk Assessment Tool (DRAT) on the HealthHub website or the HealthHub app to assess their risk of getting DM. Those who have been found to be high risk using the DRAT assessment should undergo formal blood test screening.
Diabetes Risk Assessment Tool
Diabetes Screening (CDMP Handbook guidelines)5
The recommended investigations for screening of DM in asymptomatic individuals aged ≥40 and/or with risk factors for DM are as follows:
Asymptomatic individuals with a result suggestive of DM based on the above tests should have a repeat test on a subsequent day. For these patients, when two different tests are available and the results are above the diagnostic thresholds, the diagnosis of DM is confirmed.
If HbA1c is used as the screening test, the following interpretation and follow-up testing is recommended.
Summary of HbA1c Screening Guidelines5
High risk of DM
Age ≥40 years
Low probability of DM.
No further tests needed if there are no symptoms of DM.*
Further testing with an FPG or 2-hr OGTT is recommended in the presence of clinical suspicion of DM.
Maintain healthy lifestyle and weight. Repeat test in 3 years.
OR 2-hr OGTT <7.8 mmol/L
FPG 6.1-6.9 mmol/L
OR 2-hr OGTT 7.8-11.0 mmol/L
Manage as per Appropriate Care Guidelines (ACG).
OR 2-hr OGTT ≥11.1mmol/L
* Symptoms of DM include: frequent urination, increased thirst, weight loss with no obvious cause, frequent skin infections, slow wound healing and blurring of vision. Of note, these symptoms are not specific for DM.