More Type 2 Diabetes Screening Advised for Overweight, Obese Adults

The US Preventive Services Task Force (USPSTF) is calling clinicians to screen for type 2 diabetes and abnormal blood glucose levels in overweight and obese adults ages 40 to 70.¹

Even in adult patients who are not overweight or obese, the USPSTF says screening may be appropriate in those who:

• Have a family history of diabetes,
• Have a history of gestational diabetes or polycystic ovarian syndrome (PCOS), or
• Belong to certain racial/ethnic groups (eg, African Americans, American Indians/Alaskan Natives, Asian Americans, Hispanics/Latinos, or Native Hawaiians/Pacific Islanders)¹

Previously, the USPSTF only recommended such screening in asymptomatic adults with a sustained blood pressure (either treated or untreated) of 135/80 mm Hg or higher.²

Although early drafts of the agency’s current recommendation called for blood glucose screening based on type 2 diabetes risk factors,³this strategy was largely discarded in favor of screening based on body mass index (BMI), despite the fact that the American Association of Clinical Endocrinologists and the American Academy of Family Physicians continue to recommend screening for abnormal blood glucose levels based on risk factors alone.¹

This updated recommendation simplifies screening substantially and may help clinicians identify more of the estimated 86 million Americans aged 20 years or older who have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). In these patients, the risk of developing type 2 diabetes can be reduced substantially through lifestyle changes, though the USPSTF is uncertain about the current evidence for pharmacologic weight loss interventions.¹

Of the available glucose tolerance tests, glycosylated hemoglobin levels may be the most convenient for screening purposes. Unlike fasting plasma glucose testing and oral glucose tolerance testing, glycosylated hemoglobin level measurement can be performed without regard to meals.

After initial testing of at-risk individuals, USPSTF panelists recommend rescreening every 3 years if blood glucose levels are normal.¹

These changes have important implications for managed care. Under the Affordable Care Act, USPSTF-recommended preventive services such as screening must be covered by private insurance plans at no cost to the patient.⁴This means that overweight and obese patients with private insurance can now receive tests for IFG and IGT free of charge.

By recommending screening in adults ages 40 to 70 with a BMI in the overweight or obese category, clinicians may have a larger window of opportunity to prevent type 2 diabetes in at-risk patients.

References

1. United States Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes. Published October 27, 2015. Accessed October 27, 2015.

2. United States Preventive Services Task Force. Archived Final Recommendation Statement

Diabetes Mellitus (Type 2) in Adults: Screening, June 2008. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/diabetes-mellitus-type-2-in-adults-screening. Originally published June 30, 2008. Last updated December 30, 2013. Accessed October 27, 2015.

3. United States Preventive Services Task Force. Draft Recommendation Statement

Abnormal Glucose and Type 2 Diabetes Mellitus in Adults: Screening.

https://web.archive.org/web/20150118013846/http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus#tab. Last updated October 7, 2014. Accessed October 27, 2015.

4. Patient Protection and Affordable Care Act. http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf#page=13. Accessed October 27. 2015.