medwireNews: The US Preventive Services Task Force (USPSTF) has recommended lowering the age of screening for prediabetes and type 2 diabetes to 35 years for people with overweight or obesity.
The updated recommendation is published in JAMA, along with an evidence report, an editorial, a previously released analysis of diabetes and risk factor control in US adults, and a study using the SEARCH registry to examine diabetes rates in US children.
The new age threshold for screening (in nonpregnant adults in primary care) represents a reduction of 5 years from the 2015 recommendation. And Karina Davidson (Feinstein Institutes for Medical Research, New York) and Taskforce co-authors suggest screening at even lower ages for the following high-risk ethnic groups: American Indians/Alaska Natives; Black people; Hawaiian/Pacific Islanders; and Hispanic/Latino people.
In addition, they advise a lower BMI threshold of 23 kg/m2 for Asian Americans. The team notes that the optimal screening interval is “uncertain,” but suggest every 3 years for people with initially normal blood glucose levels.
The accompanying evidence report, by Daniel Jonas (The Ohio State University, Columbus) and colleagues, includes 89 publications that assessed the benefits and harms of screening for prediabetes and type 2 diabetes. Very few of these, and even fewer randomized trials, directly addressed the health benefits and harms of screening asymptomatic adults, and no trials addressed the optimal timing of intervention in adults with screen-detected dysglycemia.
However, there was moderate to strong evidence for the benefits of intervention in people with prediabetes and recently diagnosed type 2 diabetes.
The editorial authors, Edward Gregg (Imperial College London, UK) and Tannaz Moin (University of California, Los Angeles, USA), point out that “[m]ore than 40% of the adult population will be eligible for the screening, among whom an estimated one-third most likely will meet USPSTF criteria for a prevention program.”
They also cite data suggesting that almost a quarter of adults younger than 45 years have prediabetes, and say that “young adults appear to be the group with the most to lose by current levels of diabetes care delivery and the most to gain by attention to the new recommendation.”
In their editorial, Gregg and Moin cite recent evidence of rising prediabetes and type 2 diabetes rates in adults, of “potential stagnation of diabetes care and outcomes,” and of the “ongoing missed opportunity” to intervene in people found to have prediabetes.
They say that addressing these issues “calls for new ideas, new science, and perhaps new frameworks.”
The editorialists propose a “broader framework for diabetes prevention,” which matches an individual’s level of risk to “diverse evidence-based interventions.”
They believe this “may enhance engagement and uptake” and “may ultimately complement the population-based policies needed to change population-level risk.”
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