New Diabetes Screening Guidelines Miss More Than Half of High-Risk Patients

Jennifer G. Allen
Published Online: Tuesday, July 19th, 2016
The latest federal diabetes screening recommendations fail to catch 55% of adults at high risk for diabetes, a recent investigation found.
 
The October 2015 guidelines from the US Preventive Service Task Force (USPSTF) recommend diabetes screening for patients who are overweight and obese and between the ages of 40 and 70 years. Even in adult patients who are not overweight or obese, the USPSTF says screening may be appropriate in those who:
  • Have a family history of diabetes,
  • Have a history of gestational diabetes or polycystic ovarian syndrome, or
  • Belong to certain racial/ethnic groups (eg, African Americans, American Indians/Alaskan Natives, Asian Americans, Hispanics/Latinos, or Native Hawaiians/Pacific Islanders)1
Previously, the USPSTF only recommended such screening in asymptomatic adults with a sustained blood pressure (either treated or untreated) of 135/80 mm Hg or higher.2
 
Notably, since the Affordable Care Act requires all insurers to fully cover services recommended by the USPSTF, patients who do not meet these criteria likely would have to pay out of pocket for such screening.
 
The study, which was conducted by researchers from the Northwestern University School of Medicine and recently published in PLOS Medicine, used data from 50,515 electronic health records (EHR) for adult primary care patients at community health centers in the US Southwest and Midwest from 2008 to 2013. It found that among all patients who developed dysglycemia, only 54% of whites, 50% of African Americans, and 37% of Latinos qualified for screening under the new guidelines.
 
The researchers were not surprised by the racial disparities uncovered in their analysis.
 
“We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites,” said lead study author Dr. Matthew O’Brien in a university press release.
 
Dr. O’Brien offered the following illustration: “Say I’m caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy. She shouldn’t be screened, according to the guidelines, but she’s very likely to have either prediabetes or diabetes.”
 
The researchers noted that USPSTF guidelines are on the right track because they are based on the 2 most important risk factors for diabetes: weight and age. Yet, the results of their analysis suggest that additional risk factors are needed to capture a greater proportion of patients who should be screened for diabetes.
 
Moving forward, Dr. O’Brien and colleagues recommended some next steps to improve upon current procedures. First, they called on the USPSTF to select additional factors to qualify more patients for diabetes screening. Second, they suggested that EHRs be used to alert care providers to screen patients with qualifying risk factors.
 
For clinicians, expanding upon USPSTF recommendations may create a larger window of opportunity to prevent type 2 diabetes in at-risk patients.
 
“Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly,” Dr. O’Brien continued, “If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes.”


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