NICE PH38 recommends a two-stage approach for identifying people at high risk of developing diabetes. This involves using a validated risk assessment score and a blood test for those identified at high risk to assess more accurately their future risk of diabetes.9

Currently, the NHS Health Check programme initially uses body mass index and/or blood pressure (systolic and/or diastolic) to identify people at risk of diabetes:

·       BMI ‰¥ 30 or ‰¥27.5 in individuals from Indian, Pakistani, Bangladeshi, other Asian and Chinese ethnicity background;

·       blood pressure ‰¥140/90mmHg, or (SBP) ‰¥140mmHG or diastolic DBP ‰¥90mmHg.

The 2017 update to the Best Practice Guidance for NHS Health Check recommends that a validated tool is used to assess the risk of type 2 diabetes as part of an NHS Health Check. It notes that €there is no single universally recognised blood test for high risk of diabetes or for diabetes itself. Random (non-fasting) plasma glucose tests are so influenced by food they are not recommended.€10

Although less convenient, fasting plasma glucose tests are considered a better method, and an HbA1c test or point of care test (POCT) can also be used. These have been shown to be appropriate for the initial filtering out people who are unlikely to have diabetes or non-diabetic hyperglycaemia. Using POCT during an NHS Health Check can also be cheaper than laboratory-based testing, and means the number of 'no shows' or did not attends (DNAs) associated with laboratory testing is reduced. The NHS Health Check can be completed in one sitting.10,11

Nevertheless, €diagnosis of diabetes or of non-diabetic hyperglycaemia requires a venous blood sample to be tested in the laboratory.€10