The American Diabetes Association currently recommends that screening for type 2 diabetes “should begin at age 45 for all people.” Now, however, the U.S. Preventive Services Task Force, a volunteer panel of U.S.-based experts in disease prevention and evidence-based medicine, is proposing the standard be changed to age 35 for overweight or obese people.
Recently, the task force opened their Draft Recommendation Statement to a public comment period before they release the final version. This, they say, was “in an effort to maintain a high level of transparency in our methods.”
They begin their case for earlier screening by pointing out a great many people seemingly have diabetes without knowing it or being told they have it. It’s estimated, the task force members say, that 13% of all U.S. adults (18 and up) have diabetes and more than a third (34.5%) meet the criteria for prediabetes. In addition, “The prevalence of prediabetes and diabetes are higher in older adults. Of those with diabetes, 21.4% were not aware of or did not report having diabetes, and only 15.3% of persons with prediabetes reported being told by a health professional that they had this condition.”
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The task force argues that screening can help prevent diabetes or prediabetes from getting worse and thereby contributing to other health problems. For example, a person diagnosed with prediabetes can make dietary changes and increase physical activity and perhaps begin taking metformin, while an earlier diagnosis of type 2 diabetes can help the affected person through an earlier start of treatment.
Update to a 2015 diabetes screening proposal
In 2015 the task force advised that screening of overweight or obese people should begin at age 40. In order to update that proposal, they commissioned a systematic review of the evidence on screening for prediabetes and type 2 diabetes in “asymptomatic nonpregnant adults and preventive interventions for those with prediabetes.” The review surveyed 89 publications. The researchers found convincing evidence that blood sugar control interventions, such as the use of insulin, metformin, or sulfonylureas, “improved a number of health outcomes, including all-cause mortality, diabetes-related mortality and myocardial infarction over 10 to 20 years.”
In addition, the task force did a meta-analysis (analysis of data from several clinical trials) of 23 trials that studied the effect of lifestyle interventions on the delay or prevention of type 2 diabetes and found that interventions that stressed diet, nutrition, and physical activity were associated with a 22% reduction in the development of the disease. Interventions were also related to reductions in weight, body-mass index, and blood pressure, while “high-contact lifestyle interventions” were associated with reduced triglyceride levels and increased levels of HDL cholesterol (the so-called “good cholesterol”).
The researchers found scant indication any of these interventions were in any way harmful. Four studies of drug treatments found no difference between them and a placebo (inactive treatment), although three trials reported higher rates of gastrointestinal troubles associated with metformin. How often should people be screened? According to the report, evidence on this matter is “limited,” but “Cohort and modeling studies suggest that screening every 3 years may be a reasonable approach for adults with normal blood glucose levels.”
Task force member Chien-Wen Tseng, MD, summarized their findings by saying, “The task force found there are effective ways to help people who have prediabetes lower their risk of diabetes and improve their overall health. Clinicians and patients should discuss these benefits and choose the approach that works best for each individual.” Another task force member, Michael Barry, MD, commented in a press release, “Screening and earlier detection can help prevent prediabetes and diabetes from getting worse and leading to other health problems.”
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