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Screening Tests for Adults (50 and Up)

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Not everyone in this age group may need screening for every condition listed here. Click on the links above to read more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Diabetes

Diabetes is the seventh leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 28.9 million people age 20 and older, or 12.3% of all people in this age group, have diagnosed or undiagnosed diabetes. Of these, 13.4 million are 45-64 and 11.2 million are 65 years of age or older. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults. Unhealthy weight and physical inactivity, also significant national health problems, are both contributing factors to the rising incidence of type 2 diabetes.

Another 86 million American adults aged 20 years or older have prediabetes, meaning that their blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. Detecting prediabetes allows individuals take steps to stop or slow the development of type 2 diabetes and its complications. These include heart attack, stroke, hypertension, blindness and eye problems, kidney disease, and nervous system maladies. More than 60% of lower limb amputations occur in diabetics.

Another complication is hearing loss. It is twice as common in people with diabetes as it is in those who don't have the disease. Among adults with prediabetes, the rate of hearing loss is 30% higher than in those with normal blood glucose levels, according to the American Diabetes Association (ADA).

Risk Factors
Being overweight – having a body mass index (BMI) equal to or greater than 25 kg/m2 – is a major risk factor for type 2 diabetes.

Other risk factors related to your own health include:

  • Physical inactivity
  • Having high blood pressure (hypertension), meaning blood pressure 140/90 mmHg or higher or receiving therapy for hypertension
  • History of cardiovascular disease
  • Having a HDL-cholesterol level less than 35 mg/dL (0.90 mmol/L) and/or a triglyceride level greater than 250 mg/dL (2.82 mmol/L)
  • Having a previous A1c test result equal to or greater than 5.7%, impaired glucose tolerance, or impaired fasting glucose
  • Having other conditions associated with insulin resistance, such as severe obesity and acanthosis nigracans

Family-related risk factors are:

  • Having a parent or sibling with diabetes
  • Being of African American, Latino, Native American, Asian American, or Pacific Islander descent

Women's risk factors include:

Screening tests

  • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
  • A1c (also called hemoglobin A1c or glycohemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended more recently as another test to screen for diabetes.
  • 2-hour glucose tolerance test (OGTT) – this test involves drawing a fasting blood test, followed by having the person drink a 75-gram glucose drink and then drawing another sample two hours after consuming the glucose.

If the initial result is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.

Recommendations
The ADA and the U.S. Preventive Services Task Force (USPSTF) recommend that:

  • All people age 45 and older get screening for type 2 diabetes, even if they have no symptoms or risk factors other than age. If you have additional risk factors, screening is especially important.
  • Even if initial screening results are normal, get repeat testing at least every 3 years, according to the ADA. However, the USPSTF advises yearly screening thereafter.
  • If you have been diagnosed with prediabetes, get tested yearly.

The American Association of Clinical Endocrinologists (AACE) also recommends diabetes screening for asymptomatic people with these risk factors, as well as those on antipsychotic therapy for schizophrenia or who have severe bipolar disease.

As public health experts work to educate Americans on what to do to avoid this disease and its serious complications, be aware that healthy eating habits and activity choices can lower your risk of developing type 2 diabetes and of suffering complications from the disease.


Links
NIDDK: Am I at Risk for Type 2 Diabetes?
National Diabetes Education Program
National Diabetes Information Clearinghouse: Diagnosis of Diabetes and Prediabetes
American Diabetes Association: Diabetes Basics 


Sources Used in Current Review

Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. PDF available for download at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf through http://www.cdc.gov. Published 2011. Accessed August 24, 2012.

American Diabetes Association. Standards of Medical Care in Diabetes – 2012. Diabetes Care. Available online at http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf+html through http://care.diabetesjournals.org. Published January 2012. Accessed August 27, 2012

American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. PDF available for download at https://www.aace.com/files/dm-guidelines-ccp.pdf through https://www.aace.com. Published March/April 2011. Accessed September 7, 2012.

U.S. Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiab.htm#summary through http://www.uspreventiveservicestaskforce.org. Published June 2008. Accessed September 7, 2012.

National Center for Health Statistics Data Brief. Prevalence of Obesity in the United States, 2009–2010. PDF available for download at http://www.cdc.gov/nchs/data/databriefs/db82.pdf through http://www.cdc.gov. Published January 2012. Accessed September 10, 2012.

American Diabetes Association. Living with Diabetes: Diabetes and Hearing Loss. Available online at http://www.diabetes.org/living-with-diabetes/seniors/hearing-loss/ through http://www.diabetes.org. Accessed September 11, 2012.

(Updated 2014 July 28) National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention [On-line information]. Available online at http://www.cdc.gov/diabetes/pubs/statsreport14.htm through http://www.cdc.gov. Accessed September 2014.

(2014 January) Standards of Medical Care in Diabetes 2014. Diabetes Care Volume 37, Supplement 1 [On-line information]. Available online at http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html through http://care.diabetesjournals.org. Accessed September 2014.

(October 2014) U.S. Preventive Services Task Force. Draft Recommendation Statement. Abnormal Glucose and Type 2 Diabetes Mellitus in Adults: Screening. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus through http://www.uspreventiveservicestaskforce.org. Accessed November 22, 2014.

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