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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.