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VOLUME 11 NUMBER 4 • NOVEMBER 2014
171
SA JOURNAL OF DIABETES & VASCULAR DISEASE
LEARNING FROM PRACTICE
Methods
An online survey open to all health professionals caring for patients
with diabetes in the UK was conducted for four months (December
2013 to March 2014). Data were collected using a questionnaire
consisting of seven questions designed in light of the IDF statement
(Table 2). The survey was publicly announced on the Association
of British Clinical Diabetologists (ABCD) and Diabetes UK websites
and in the Diabetes UK professional newsletter (Update, December
2013), and on the Young Diabetologist’s and Endocrinologist’s forum
(YDEF) website which provided the links to access the online survey.
In order to maintain confidentiality all responses were anonymous.
The first two sections of the questionnaire sought to determine
demographic data (location of provision of diabetes care and role
of the respondent). Questions 1 and 2 aimed to gauge current
awareness of the IDF guidance; question 3 to investigate adoption
of the IDF recommendations by local diabetes pathways; And
questions 4 and 5 ascertained the perceived roles for investigating
OSA in diabetes patients.
Results
A total of 62 responses were received, mainly from hospital-based
physicians (Fig. 1), and showed that a minority of respondents were
aware of the IDF guidelines and their implications for practice, but
78% of respondents noted that diabetes patients with suspected
OSA are investigated by the respiratory team (Table 3). Appendix
1 (available online at
www.bjdvd.com) documents questionnaire
responses according to role and location. It is noteworthy that all
respondents did not answer all questions.
Discussion
The majority (approximately two-thirds) of diabetes healthcare
professionals who responded to this survey were not aware of the
IDF recommendations either for diabetes screening in OSA patients
or for OSA assessment in type 2 diabetes and obesity. Secondly,
most participants indicated that their local diabetes guidelines did
not incorporate assessment for OSA in those deemed to be at risk.
Thirdly, for the vast majority of participants, assessments were
deemed to be primarily the domain of the respiratory team and not
the diabetes team.
A beneficial effect of OSA treatment with CPAP in terms of blood
pressure reduction was found in patients with type 2 diabetes,
19
although the research on the influence of CPAP therapy on glucose
homeostasis has yielded mixed findings.
20
Nevertheless, it has been
proposed that there may be a role for a multifaceted approach
for these individuals in order to manage their cardiometabolic
risks.
21
A recent observational study of OSA patients with type 2
diabetes assessed clinical outcomes and cost-effectiveness of CPAP
treatment compared with non-treatment. It was found that CPAP
use was associated with significantly lower blood pressure, improved
glycaemic control, and was more cost-effective than no treatment
with CPAP,
22
and a strategy has been proposed to identify, screen
and diagnose patients with type 2 diabetes and OSA.
23
Table 2.
Questionnaire on OSA assessment
Please tick the relevant boxes.
Location: Teaching/University Hospital
q
District General Hospital
q
GP Practice
q
Role: Consultant
q
Registrar
q
Diabetes Specialist Nurse
q
Other
q
Yes No Don’t Know
1. I know IDF guidance to screen for diabetes in OSA?
q q q
2. I know IDF guidance to screen for OSA in high risk patients with diabetes & obesity?
q q q
3. Our local diabetes guidelines recommend OSA screening in diabetes patients at risk of OSA?
q q q
4. Local people with diabetes suspected of OSA are investigated by diabetes team?
q q q
5. Local people with diabetes suspected of OSA are investigated by respiratory team?
q q q
Figure 1.
Questionnaire results showing location of work and role of respond-
ents (
n
= 62).
Table 3.
Responses to questions 1–5. Total number of respondents = 62*
Responses
Question
Yes
No
Don’t know
1. I know IDF guidance to screen for diabetes in OSA?
32% (
n
= 19)
38% (
n
= 23)
30% (
n
= 18)
2. I know IDF guidance to screen for OSA in high risk patients with diabetes & obesity?
34% (
n
= 21)
38% (
n
= 23)
28% (
n
= 17)
3. Our local diabetes guidelines recommend OSA screening in diabetes patients at risk of OSA?
19% (
n
= 12)
45% (
n
= 28)
36% (
n
= 22)
4. Local people with diabetes suspected of OSA are investigated by diabetes team?
12% (
n
= 7)
67% (
n
= 40)
21% (
n
= 13)
5. Local people with diabetes suspected of OSA are investigated by respiratory team?
78% (
n
= 48)
3% (
n
= 2)
19% (
n
= 12)
*Some respondents did not answer all questions: two skipped question 1; one skipped question 2; two skipped question 4.