Vol 73, No 2 (2022)
Original article
Published online: 2022-06-29
Screening for type 2 diabetes and hypertension in seafarers’ medical examinations
1
, 23, 14, 5, 67, 8, 910, 11, 11, 12, 13, 14, 15
, 23, 14, 5, 67, 8, 910, 11, 11, 12, 13, 14, 15
Abstract
Background: The aims of the study are: 1) to replace the urine glucose test for diabetes with more than 50% false negatives, with an accurate screening for type 2 diabetes and hypertension in the mandatory biannual fit-for-duty medical examinations of seafarers; 2) to produce data driven “Green Ship” health promotion in the ships. A new health promotion and disease prevention public health intervention programme integrated in the fit-for-duty medical examinations for seafarers is being developed. Materials and methods: The lack of an accurate diagnosis of type 2 diabetes is replaced by accurate HbA1c and/or fasting glucose tests and the test for hypertension in various disease stages is based on the International Associations’ Guidelines. A “Green Ship” health promotion programme is proposed for all on board, not only for diseased crew members. Results: A protocol for an accurate biannual screening for diabetes and hypertension is presented. Educational programmes for medical doctors and seafarers on the management of hypertension and diabetes on board will be developed. Presuming that all crew members are potentially on their way to be pre-diseased or are diseased, the “Green Ship” health promotion programme is implemented for the whole crew. Conclusions: The International Labour Organization and the National Maritime Authorities are prompted to revise the International and the National Guidelines for Seafarers Medical Examinations, respectively. Concerted actions are requested to implement public health promotion projects in shipping. Maritime medical doctors are prompted to use health dialogues and to report the clinical data in the Excel file. Sustainability is obtained by complying with the Sustainable Development Goals (3, 4, 8, 10, and 17).
Keywords: type 2 diabeteshypertensionseafarersfishermenscreeningearly diagnosismetabolic syndrome
References
- Who Are Seafarers & Why Do They Matter? [Internet]. Clear Seas. 2017. https://clearseas.org/en/blog/why-seafarers-matter/ (cited 2022 Feb 1).
- Maritime Labour Convention, 2006 [Internet]. https://www.ilo.org/global/standards/maritime-labour-convention/lang--en/index.htm (cited 2022 Feb 26).
- Guidelines on the medical health examination for seafarers wcms_1. https://www.ilo.org/sector/Resources/codes-of-practice-and-guidelines/WCMS_174794/lang--en/index.htm (cited 2022 March 23).
- Nittari G, Tomassoni D, Di Canio M, et al. Overweight among seafarers working on board merchant ships. BMC Public Health. 2019; 19(1): 45.
- Oldenburg M, Jensen HJ, Latza U, et al. Coronary risks among seafarers aboard German-flagged ships. Int Arch Occup Environ Health. 2008; 81(6): 735–741.
- Tu M, Jepsen JR. Hypertension among Danish seafarers. Int Marit Health. 2016; 67(4): 196–204.
- Herttua K, Ahrenfeldt LJ, Paljarvi T. Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study. Occup Environ Med. 2022; 79(3): 162–168.
- Kaerlev L, Dahl S, Nielsen PS, et al. Hospital contacts for chronic diseases among danish seafarers and fishermen: a population-based cohort study. Scand J Public Health. 2007; 35(5): 481–489.
- New Guidance on Blood Pressure Management in Low-Risk Adults with Stage 1 Hypertension [Internet]. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2021/06/21/13/05/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2021%2f06%2f21%2f13%2f05%2fnew-guidance-on-bp-management-in-low-risk-adults-with-stage-1-htn (cited 2022 Feb 7).
- Alderman MH. Non-pharmacological treatment of hypertension. Lancet. 1994; 344(8918): 307–311.
- Taylor R, Al-Mrabeh A, Sattar N. Understanding the mechanisms of reversal of type 2 diabetes. Lancet Diabetes Endocrinol. 2019; 7(9): 726–736.
- Jensen OC, Flores A, Corman V, et al. Early diagnosis of T2DM using high sensitive tests in the mandatory medical examinations for fishers, seafarers and other transport workers. Prim Care Diabetes. 2022; 16(1): 211–213.
- Jensen OC, Flores A, Corman V, et al. Rethinking the use of urine dipstick for early diagnosis of type 2 diabetes mellitus. Diabetes Res Clin Pract. 2022; 184: 109222.
- Friderichsen B, Maunsbach M. Glycosuric tests should not be employed in population screenings for NIDDM. J Public Health Med. 1997; 19(1): 55–60.
- The International Diabetes and Hypertension Research Group in seafaring, fishing and transport workers [Internet]. University of Southern Denmark. https://portal.findresearcher.sdu.dk/en/projects/the-international-diabetes-and-hypertension-research-group-in-sea (cited 2022 Feb 18).
- Brown P. Waist circumference in primary care. Prim Care Diabetes. 2009; 3(4): 259–261.
- Lean M, Han TS, Seidell JC. Impairment of health and quality of life in people with large waist circumference. Lancet. 1998; 351(9106): 853–856.
- Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020; 75(6): 1334–1357.
- Diagnosis | ADA [Internet]. https://www.diabetes.org/diabetes/a1c/diagnosis (cited 2022 Feb 12).
- International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009; 32(7): 1327–1334.
- Consensus Committee. Consensus statement on the worldwide standardization of the hemoglobin A1C measurement: the American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation. Diabetes Care. 2007; 30(9): 2399–2400.
- Ollerton RL, Playle R, Ahmed K, et al. Day-to-day variability of fasting plasma glucose in newly diagnosed type 2 diabetic subjects. Diabetes Care. 1999; 22(3): 394–398.
- Knudsen JS, Knudsen SS, Hulman A, et al. Changes in type 2 diabetes incidence and mortality associated with introduction of HbA1c as diagnostic option: A Danish 24-year population-based study. Lancet Reg Health Eur. 2022; 14: 100291.
- Danish Medical_certificate copy.pdf.
- Self-Declaration - Serial No. of Medical CertificateDeclaration of u.pdf.
- For sundhedsfaglige [Internet]. https://www.sundhed.dk/sundhedsfaglig/ (cited 2022 Feb 7).
- English - DSAM - Dansk Selskab for Almen Medicin [Internet]. https://www.dsam.dk/english/ (cited 2022 Feb 7).
- Type 2-diabetes - DSAM Vejledninger [Internet]. https://vejledninger.dsam.dk/type2/?mode=visKapitel&cid=539 (cited 2022 Feb 7).
- Diabetes type 2 - sundhed.dk [Internet]. https://www.sundhed.dk/sundhedsfaglig/information-til-praksis/nordjylland/almen-praksis/patientforloeb/forloebsbeskrivelser/t-endokrinologi-metabolik-ernaering/diabetes2/ (cited 2022 Jan 28).
- Rogvi SÁ, Guassora AD, Wind G, et al. Adjusting health care: practicing care for socially vulnerable type 2 diabetes patients. BMC Health Serv Res. 2021; 21(1): 949.
- Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens. 2020; 38(6): 982–1004.
- Recommendations for Blood Pressure Measurement in Humans and Experimental Animals [Internet]. https://www.ahajournals.org/doi/epub/10.1161/01.CIR.0000154900.76284.F6 (cited 2022 Feb 7).
- How to accurately measure blood pressure at home [Internet]. www.heart.org. https://www.heart.org/en/news/2020/05/22/how-to-accurately-measure-blood-pressure-at-home (cited 2022 Feb 7).
- Handler J. The importance of accurate blood pressure measurement. Perm J. 2009; 13(3): 51–54.
- Kennedy C, Farnan R, Stinson J, et al. Referrals to, and characteristics of patients attending a specialist hypertension clinic. J Hum Hypertens. 2022; 36(3): 315–324.
- Meador M, Lewis JH, Bay RC, et al. Who are the undiagnosed? Disparities in hypertension diagnoses in vulnerable populations. Fam Community Health. 2020; 43(1): 35–45.
- Wong MCS, Wang HHX, Kwan MWM, et al. The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: A randomised clinical trial. Int J Cardiol. 2016; 224: 79–87.
- World Health Organization. International medical guide for ships : including the ship’s medicine chest [Internet]. World Health Organization; 2007. https://apps.who.int/iris/handle/10665/43814 (cited 2022 Feb 7).
- Download inventory lists [Internet]. https://dma.dk/seafarers-and-manning/person-in-charge-of-medical-care/download-inventory-lists (cited 2022 Feb 7).
- Handbook for seafarer medical examiners - Google-søgning [Internet]. 2018. https://www.google.com/search?source=hp&ei=g635W93PBcrl5gKxu7q4Cw&q=+Handbook+for+seafarer+medical+examiners+&btnK=Google-s%C3%B8gning&oq=+Handbook+for+seafarer+medical+examiners+&gs_l=psy-ab.3..0i22i30.2027.2027..2397...1.0..0.380.492.0j1j0j1......0....1j2..gws-wiz.....6..35i39.Y_FFLFrz5yo (cited 2018 Nov 24).
- Baygi F, Djalalinia S, Qorbani M, et al. Lifestyle interventions in the maritime settings: a systematic review. Environ Health Prev Med. 2020; 25(1): 10.
- Jepsen JR, Rasmussen HB. The metabolic syndrome among Danish seafarers: a follow-up study. Int Marit Health. 2016; 67(3): 129–136.
- Stevens JW, Khunti K, Harvey R, et al. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions. Diabetes Res Clin Pract. 2015; 107(3): 320–331.
- Sortsø C, Komkova A, Sandbæk A, et al. Effect of screening for type 2 diabetes on healthcare costs: a register-based study among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009. Diabetologia. 2018; 61(6): 1306–1314.
- Lee HY, Lee SW, Kim HC, et al. Cost-Effectiveness analysis of hypertension screening in the Korea National Health Screening Program. Korean Circ J. 2021; 51(7): 610–622.
- Kaur G, Chauhan AS, Prinja S, et al. Cost-effectiveness of population-based screening for diabetes and hypertension in India: an economic modelling study. Lancet Public Health. 2022; 7(1): e65–e73.
- Siu AL. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015; 163(10): 778–786.
- People focus: Diabetes and the seafarer - GARD [Internet]. https://www.gard.no/web/updates/content/28676231/people-focus-diabetes-and-the-seafarer (cited 2021 Dec 31).
- Workplace health promotion and well-being (Occupational Safety and Health) [Internet]. https://www.ilo.org/safework/areasofwork/workplace-health-promotion-and-well-being/lang--en/index.htm (cited 2022 Feb 10).
- Project > e-healthy ship [Internet]. https://www.e-healthy-ship.eu/en/project/ (cited 2022 Feb 6).
- Heidrich J, Dengler D, Zyriax BC, et al. Concept of a multi-method study on health promotion and health care in commercial shipping. Eur J Public Health. 2018; 28(suppl_4).
- Barclay AR. Workplace health promotion in the commercial fishing industry: a case study of Port Lincoln [Internet]. 2015. https://hekyll.services.adelaide.edu.au/dspace/handle/2440/97883 (cited 2017 Aug 31).
- Neumann FA, Belz L, Dengler D, et al. Eating behaviour and weight development of European and Asian seafarers during stay on board and at home. J Occup Med Toxicol. 2021; 16(1): 41.
