After a review of the available evidence, the U.S. Preventive Services Task Force has issued new recommendations for screening overweight and obese adults for prediabetes and type 2 diabetes — which include lowering the screening age from 40 to 35, according to a recommendation statement published in the journal JAMA.
The task force’s recommendations serve an important role in the U.S. health care system, since they establish many services that must be covered by health insurance plans — both private and public — as preventive care. Under federal law, most health insurance plans must cover certain preventive care services without any out-of-pocket charges for those services. Even when a health insurance plan isn’t required to cover a service as preventive care, it may decide to do so based on a determination that the service is likely to result in health care savings down the line, ultimately saving money — and, in many cases, improving health at the same time.
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New type 2, prediabetes screening recommendations
The latest recommendations, based on a systematic review of clinical trials, are an update to previous recommendations published in 2015. They apply only to adults who aren’t experiencing any signs or symptoms of diabetes or prediabetes — anyone who shows potential signs of diabetes, regardless of age or weight status, should undergo tests for diabetes. In particular, the task force now recommends blood glucose screening for “nonpregnant adults aged 35 to 70 years seen in primary care settings who have overweight or obesity … and no symptoms of diabetes.” Overweight is defined as having a body-mass index (BMI, a measure of body weight that takes height into account) of 25 or greater but less than 30, while obese is defined as having a BMI of 30 or greater.
The task force concluded with “moderate certainty,” based on all available evidence, that screening for prediabetes or type 2 diabetes starting at age 35 in this population — and referring anyone with prediabetes to a diabetes prevention intervention — has a “moderate net benefit” when it comes to outcomes related to diabetes. The benefits of screening are considered moderate because based on a number of different studies, detecting and treating diabetes earlier doesn’t lead to improvements in certain outcomes until 10 to 20 years later. For example, the recommendation states that intensive glucose control with the diabetes drug metformin was shown to significantly reduce all-cause and diabetes-related mortality, as well as the risk for a heart attack, after 10 years of follow-up and again after another 10 years. But several studies found no difference in the risk of death resulting from treating screening-detected diabetes after five to 10 years.
In a related editorial published in JAMA, the authors point out that under the new recommendations, more than 40% of the U.S. adults population will now be eligible for diabetes and prediabetes screening. And based on the likely results of this screening, it’s estimated that one-third of people who get screened will be eligible for a diabetes prevention program. While these programs could, in theory, lead to enormous health and cost-saving benefits, the reality is that there aren’t nearly enough prevention programs available for every eligible person to sign up, and most people who are eligible don’t pursue these programs in the first place. Together, this means that only about 1% of people who are eligible for diabetes prevention or weight-loss programs actually participate in them.
“Overcoming a gap so large calls for new ideas, new science, and perhaps new frameworks,” the editorial authors wrote. “Development of a broader framework for diabetes prevention that matches risk tiers to diverse evidence-based interventions to serve individuals at varying levels of risk, and that provides more personalized prevention or metformin, may enhance engagement and uptake.”
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