USPSTF proposes ‘major change’ to prediabetes, diabetes screening recommendations
The U.S. Preventive Services Task Force released a draft recommendation that, if adopted, would lower the age to start screening adults with overweight or obesity for prediabetes and type 2 diabetes from 40 to 35 years.
These patients should continue to be screened for prediabetes and type 2 diabetes until they are aged 70 years, the task force said.
The lower baseline age for screening, which carries a B grade, is a “major change” from the 2015 final USPSTF recommendation in this clinical area, said Chien-Wen Tseng, MD, MPH, MSE, a task force member and research director in the department of family medicine and community health at the University of Hawaii John A. Burns School of Medicine. She added that changes in epidemiological data prompted the revised recommendation.
“Unfortunately, within our communities, the rates of being overweight or obese have increased in people of younger ages,” Tseng told Healio Primary Care. “We’re also seeing that rates of diabetes are also increasing in younger age groups as well.”
Other risk factors related to the development of prediabetes or type 2 diabetes include family history, gestational diabetes, polycystic ovarian syndrome, older age and unhealthy diet and lifestyle. Compared with non-Hispanic whites and Asians, the prevalence of diabetes is higher among American Indians/Alaska Natives, non-Hispanic Blacks and Latinos/Hispanics, according to the task force.
Tseng acknowledged that while other medical societies such as the CDC and the American Diabetes Association support screening for prediabetes and type 2 diabetes, their guidelines vary depending on age or other risk factors.
She encouraged physicians to use “clinical judgment” when a patient has risk factors and is aged older or younger than what is indicated by an organization’s screening recommendations.
The USPSTF, citing CDC data, said 34.5% of all U.S. adults meet criteria for prediabetes and 13% of all U.S. adults have diabetes. Among the latter group, 21.4% did not know they had the disease or did not report having it. In addition, only 15.3% of adults with prediabetes said a health professional notified them of their status.
The authors of a related evidence review wrote that criteria for prediabetes includes impaired fasting glucose, impaired glucose tolerance and a glycated hemoglobin ranging from 5.7% to 6.4%, while type 2 diabetes is characterized as having insulin resistance and relative insulin deficiency.
The task force will accept comments on its draft recommendation for prediabetes and diabetes screening until April 12 at www.uspreventiveservicestaskforce.org/tfcomment.htm.
Jonas DE, et al. Screening for prediabetes and type 2 diabetes mellitus: An evidence review for the U.S. Preventive Services Task Force. Accessed March 16, 2021.
U.S. Preventive Services Task Force. Screening for Prediabetes and type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Draft Recommendation Statement. Accessed March 16, 2021.