Commentary by Michael Pignone, MD
Adults ages 40 to 70 years who are overweight or obese and do not have symptoms of diabetes should be screened for abnormal blood glucose levels as part of an overall cardiovascular risk assessment, according to a recommendation statement issued by the U.S. Preventive Services Task Force (USPSTF) on October 27, 2015.
Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote healthful diet and physical activity according to the statement, which was released online and published in the Annals of Internal Medicine.
“The prevalence of diabetes in the United States has been increasing for the past 15 years, commented Michael Pignone, MD, a member of the USPSTF and Professor of Medicine at the University of North Carolina-Chapel Hill. “In order to support the prevention of type 2 diabetes, this recommendation focuses on identifying abnormal blood sugar before it progresses to diabetes,” Dr. Pignone told EndocrineWeb.
“Currently, physician practice with respect to screening for abnormal blood sugar is variable,” Dr. Pignone explained. “We hope that this new recommendation will improve the consistency of appropriate screening,” he said.
“The evidence the Task Force reviewed tells us that, while people can get diabetes before age 40 or after age 70, prevention is most critical during this time period [of age 40 to 70 years]. This is because adults in this age range tend to benefit most from interventions that help prevent or delay complications from the disease. This is also the age range for which understanding diabetes and cardiovascular risk is most important,” Dr. Pignone said.
While there is limited evidence on how often these adults should be rescreened for abnormal blood glucose levels, evidence suggests that rescreening every 3 years may be a reasonable approach for adults with normal blood glucose levels, according to the USPSTF statement.
The recommendation is categorized as grade B, meaning that the USPSTF recommends the service and that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Need for Long-Term Data Cited
“The Task Force found that more studies are needed that directly evaluate the effects of screening asymptomatic adults over their lifespan, this includes studies that follow larger numbers of participants for 20 years or more and measure health outcomes and prevention of death morbidity and mortality, including non-fatal cardiovascular events,” Dr. Pignone said. “In addition, more research is needed on the effects of screening on racial/ethnic minorities whose prevalence of diabetes is higher… [as well as] U.S. data on the benefits and harms of lifestyle interventions and medical treatments for abnormal blood sugar and type 2 diabetes, and over a longer follow-up period," Dr. Pignone noted.
AMA Calls for Screening for All Individuals at High Risk for Diabetes
“While the American Medical Association (AMA) was supportive of the Task Force’s draft recommendations put forth one year ago that called for screening all individuals at high risk for diabetes, the final recommendations fall far short of meeting the needs of the American people who are suffering an epidemic of undiagnosed prediabetes and diabetes,” said President of the AMA Steven J. Stack, MD in a statement.
“The final recommendations reduce the target population of those who should be screened for diabetes—placing significantly less emphasis on the young as well as minority populations who are at high risk for undiagnosed diabetes,” Dr. Stack said. “The AMA believes that this will only create a greater barrier to reaching the 86 million American adults currently living with prediabetes who are at high risk of developing diabetes,” he said.
“The AMA is, however, very encouraged that the USPSTF is recognizing the value of intensive lifestyle interventions for people with prediabetes,” Dr. Stack noted. “One such intervention, the evidence-based National Diabetes Prevention Program (NDPP) has been shown to help patients with prediabetes avoid the onset of type 2 diabetes and its associated poor health outcomes,” he added.
October 30, 2015
Siu AL, on behalf of the U.S. Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015 Oct 27. doi: 10.7326/M15-2345. [Epub ahead of print]
American Medical Association. AMA Discouraged by Newest Screening Recommendations for Type 2 Diabetes. October 27, 2015. Available at: http://www.ama-assn.org/ama/pub/news/news/2015/2015-10-27-ama-discouraged-recommendations-type-2-diabetes.page