Reconsidering the Age Thresholds for Type II Diabetes Screening in the U.S.

Abstract

Background Type 2 diabetes (diabetes) and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent. Purpose To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines. Methods Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007–2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014. Results NNS, under universal screening, drops sharply at age 35 years, from 80 (30–34-year-olds) to 31 (35–39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield a NNS of 15, translating to $66 per positive test. Among people aged 35–44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive tests cases being missed (5,508,164 cases nationwide). Conclusions Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.

Receipt of Glucose Testing and Performance of Two US Diabetes Screening Guidelines, 2007–2012

“…Diabetes meets many of Wilson and Junger’s criteria for screening [ 12 ]: it is a major public health issue; there is an identifiable precursor phase (prediabetes); there are well-accepted glucose testing approaches to identify risk; evidence-based lifestyle and pharmaceutical interventions exist to prevent and control diabetes; and delayed diagnosis leads to progressive organ damage [ 7 , 13 ]. To date, most expert groups have recommended offering glucose testing to individuals deemed to be at high-risk for diabetes [ 10 , 14 , 15 ]. As such, various expert groups (e.g., the US Preventive Services Task Force [USPSTF] [ 16 ], American Diabetes Association [ADA] [ 17 ], UK National Institute of Health and Care Excellence [ 18 ], among others) have proposed guidelines that recommend whom to test and when.…”

Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes

“…Prior research has found that screening for dysglycemia based on a single diabetes risk factor yields lower sensitivity and higher specificity than using a greater number of risk factors. 22,23 The USPSTF's prior 2008 recommendation to screen adults with hypertension alone demonstrated sensitivity of 44.4% and specificity of 74.8%. 24 By contrast, the American Diabetes Association (ADA) recommends screening all adults who are overweight/obese with other diabetes risk factors including those currently listed in the USPSTF's expanded criteria, in addition to physical inactivity, hypertension, dyslipidemia, or cardiovascular disease.…”

Analysis of the Risk Factors and their Association with Diabetes among Population of African-Americans

“…Therefore it has been suggested that screening to be done for diabetes every 3 years in persons older than 45 years and in persons younger than 45 years (American Diabetes Association, 2010). According to Chung et al (2014), universal screening of individuals aged more than or equal to 35 years would simplify the current complex criteria for assessment for screening eligibility in primary care.…”