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Two-stage, school and community-based population screening successfully identifies individuals and families at high-risk for type 2 diabetes: the Feel4Diabetes-study

  • Manios, Yannis1
  • Mavrogianni, Christina1
  • Lambrinou, Christina-Paulina1
  • Cardon, Greet2
  • Lindström, Jaana3
  • Iotova, Violeta4
  • Tankova, Tsvetalina5
  • Civeira, Fernando6
  • Kivelä, Jemina3
  • Jancsó, Zoltán7
  • Shadid, Samyah8
  • Tsochev, Kaloyan4
  • Mateo-Gallego, Rocío9
  • Radó, Sándorné7
  • Dafoulas, George10
  • Makrilakis, Konstantinos10
  • Androutsos, Odysseas11
  • Manios, Yannis
  • Cardon, Greet
  • Lindström, Jaana
  • And 80 more
  • 1 Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece , Athens (Greece)
  • 2 Ghent University, Ghent, Belgium , Ghent (Belgium)
  • 3 National Institute for Health and Welfare, Helsinki, Finland , Helsinki (Finland)
  • 4 Medical University Varna, Varna, Bulgaria , Varna (Bulgaria)
  • 5 Medical University Sofia, Sofia, Bulgaria , Sofia (Bulgaria)
  • 6 University of Zaragoza, Zaragoza, Spain , Zaragoza (Spain)
  • 7 University of Debrecen, Debrecen, Hungary , Debrecen (Hungary)
  • 8 Ghent University Hospital, Ghent, Belgium , Ghent (Belgium)
  • 9 Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Zaragoza, Spain , Zaragoza (Spain)
  • 10 National and Kapodistrian University of Athens, Athens, Greece , Athens (Greece)
  • 11 Sport Science and Dietetics, University of Thessaly, Trikala, Greece , Trikala (Greece)
Published Article
BMC Endocrine Disorders
Springer (Biomed Central Ltd.)
Publication Date
Mar 12, 2020
Suppl 1
DOI: 10.1186/s12902-019-0478-9
Springer Nature


BackgroundThe implementation of population screening and early prevention strategies targeting individuals at high-risk for type 2 diabetes (T2D) seems to be a public health priority. The current work aimed to describe the screening procedure applied in the Feel4Diabetes-study and examine its effectiveness in identifying individuals and families at high risk, primarily for T2D and secondarily for hypertension, among vulnerable populations in low to middle-income countries (LMICs) and high-income countries (HICs) across Europe.MethodsA two-stage screening procedure, using primary schools as the entry-point to the community, was applied in low socioeconomic status (SES) regions in LMICs (Bulgaria-Hungary), HICs (Belgium-Finland) and HICs under austerity measures (Greece-Spain). During the first-stage screening via the school-setting, a total of 20,501 parents (mothers and/or fathers) of schoolchildren from 11,396 families completed the Finnish Diabetes Risk Score (FINDRISC) questionnaire, while their children underwent anthropometric measurements in the school setting. Parents from the identified “high-risk families” (n = 4484) were invited to participate in the second-stage screening, including the measurement of fasting plasma glucose (FPG) and blood pressure (BP). In total, 3153 parents participated in the second-stage screening (mean age 41.1 ± 5.6 years, 65.8% females).ResultsAmong parents who attended the second-stage screening, the prevalence of prediabetes (as defined by impaired fasting glucose; FPG 100-125 mg/dl) and T2D (FPG > 126 mg/dl) was 23.2 and 3.0% respectively, and it was found to be higher in the higher FINDRISC categories. The percentage of undiagnosed T2D among the participants identified with T2D was 53.5%. The prevalence of high normal BP (systolic BP 130-139 mmHg and/ or diastolic BP 85-89 mmHg) and hypertension (systolic BP ≥ 140 mmHg and/ or diastolic BP ≥ 90 mmHg) was 14 and 18.6% respectively, which was also higher in the higher FINDRISC categories. The percentage of cases not receiving antihypertensive treatment among the participants identified with hypertension was 80.3%.ConclusionThe findings of the current study indicate that the two-stage school and community-based screening procedure followed, effectively identified high-risk individuals and families in vulnerable populations across Europe. This approach could be potentially scalable and sustainable and support initiatives for the early prevention of T2D and hypertension.Trial registrationThe Feel4Diabetes-intervention is registered at (NCT02393872; date of trial registration: March 20, 2015).

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