Diabetes is the seventh leading cause of death in the United States and is becoming more common at younger ages. 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, 4.3 million are 20-44 years old.
While most cases of type 1 diabetes are diagnosed in those under the age of 30, the signs and symptoms often develop rapidly and the diagnosis is often made in an emergency room setting. Thus, screening for type 1 diabetes is not necessary. On the other hand, some youth with type 2 diabetes will have no signs or symptoms, especially early in the disease, and screening can be a useful tool. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults. Unhealthy weight and physical inactivity, both contributing factors, have also become national health problems.
It is estimated that 86 million American adults age 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.
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 of 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:
- Delivering a baby weighing more than 9 pounds or having had gestational diabetes
- Having polycystic ovarian syndrome
- 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.
The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF) recommend the following:
- Consider screening if you are overweight and have at least one other risk factor for diabetes.
- Even if initial screening results are normal, get repeat testing at least every 3 years, says the ADA. The USPSTF, however, advises yearly screening thereafter.
- If a person is diagnosed with prediabetes, repeat testing 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.
NIDDK: Am I at Risk for Type 2 Diabetes?
American Diabetes Association
American Diabetes Association: Be Healthy Today; Be Healthy For Life, Information for Youth and their Families, Living with Type 2 Diabetes
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.
(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.