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Task Force Updates Recommendations for Screening for PreDiabetes and Diabetes in Adults

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October 23, 2014

The U.S. Preventive Services Task Force (USPSTF) recently issued new draft recommendations on screening adults for prediabetes and type 2 diabetes. These recommendations update those issued in 2008 to include more than just individuals with high blood pressure.

The USPSTF is an independent panel of health professionals and experts. It regularly reviews the latest scientific evidence, such as research studies, to develop and update recommendations on various preventive services. The panel issues the findings as draft documents open for public comment before officially adopting them. The draft recommendations for screening for diabetes and pre-diabetes are open for public comment until November 3rd.

The new draft guidelines, which are now more closely aligned with existing guidelines from the American Diabetes Association (ADA), recommend that all adults age 45 and older be screened for prediabetes and diabetes. They also recommend screening for adults of any age with certain risk factors. These include being overweight, obese, or physically inactive, or having a first degree relative with diabetes. They also include women with a history of diabetes during pregnancy (gestational diabetes) or with polycystic ovarian syndrome.

The USPSTF guidelines differ slightly from the ADA's on the recommendation of frequency of screening. They agree with the ADA on a three-year interval for those with no risk factors and normal test results but suggest that yearly screening may be advisable for those with risk factors, even if their previous tests were normal.

Prediabetes, often referred to as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and diabetes can be diagnosed by laboratory tests that measure hemoglobin A1c (A1c) or fasting plasma glucose, or with an oral glucose tolerance test. All these tests are performed on blood samples. However, A1c measurement does not require fasting and is often more convenient than the other two tests.

Both the USPSTF and ADA cite the same cut-off levels for these tests as indicators of whether a person might be prediabetic or have type 2 diabetes. For diagnosis, the test must be repeated on two separate dates and both results must agree before a person is identified as diabetic or pre-diabetic. (For more on this, see Glucose: What does the test result mean?)

While the USPSTF did not find evidence that screening resulted in reduced death rates or cardiovascular disease, it did find "adequate evidence" that screening adults at increased risk for diabetes and treating those who have pre-diabetes with intensive lifestyle interventions have a moderate benefit in lowering the risk for progression to diabetes. The USPSTF also found that lifestyle changes such as healthy eating and increased physical activity are the "first line of therapy" for the prevention of prediabetes and diabetes as well as prevention of death from heart disease and death from all causes.

The USPSTF guidelines are not binding but are often adopted widely, and the preventive services that are recommended are generally paid for by insurance. Both the American Medical Association and the ADA applauded the new draft guidelines.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

(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 October 22, 2014.

(October 7, 2014) Kelley, Kristin J. USPSTF Draft Recommendation: Screen High-Risk Adults for Type 2 Diabetes. JournalWatch News. Available online at http://www.jwatch.org/fw109387/2014/10/07/uspstf-draft-recommendation-screen-high-risk-adults-type?query=pfw through http://www.jwatch.org. Accessed October 22, 2014.

Executive Summary: Standards of Medical Care in Diabetes—2014. Diabetes Care January 2014 vol. 37 no. Supplement 1 S5-S13. Available online at http://care.diabetesjournals.org/content/37/Supplement_1/S5.full#sec-3 through http://care.diabetesjournals.org. Accessed October 22, 2014.