USPSTF Reconsiders Diabetes Screening Age
Is 40 too late to start diabetes screening?
In a statement released March 16, 2021, the U.S. Preventive Services Task Force (USPSTF) issued new recommendation guidelines for prediabetes and type 2 diabetes screenings. Taking into account epidemiologic evidence, the USPSTF now recommends lowering the initial screening age from 40 to 35 years. (This is currently a draft recommendation statement and the document is available for public comments until April 12, 2021.)
This recommendation comes at a time when the Centers for Disease Control and Prevention (CDC) 2020 National Diabetes Statistics Report shows that an estimated 13 percent of all U.S. adults over 18 years have diabetes and 34.5 percent meet criteria for prediabetes. In fact, diabetes is now estimated to be the seventh leading cause of death in the United States according to the CDC, with more than 87,000 deaths from diabetes reported in 2019. Lowering the diabetes screening age may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes.
Then and Now
The USPSTF now recommends screening for prediabetes and type 2 diabetes in asymptomatic adults ages 35 to 70 years who are overweight or obese, and that clinicians should offer or refer patients with prediabetes to effective preventive interventions. This does not account for older age, family history, ethnicity, and certain lifestyle factors that may warrant screening at an earlier age.
If finalized, this recommendation would replace the 2015 USPSTF recommendation statement on screening for abnormal blood glucose and type 2 diabetes in asymptomatic adults, which recommended screening for abnormal blood glucose as part of cardiovascular risk assessment in adults ages 40 to 70 years who are overweight or obese. The 2015 statement also recommends that clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.
Scope of the Review
To assess the latest diabetes statistics, the USPSTF commissioned a systematic review of screening evidence and preventive interventions. This review focused on direct evidence of the benefits and harms of screening for prediabetes and type 2 diabetes, as well as the benefits and harms of interventions (such as behavioral counseling focused on diet and physical activity) for screen-detected prediabetes and type 2 diabetes or recently diagnosed type 2 diabetes. The review also looked at the evidence on the effectiveness of interventions for prediabetes to delay or prevent progression to type 2 diabetes.
The review found adequate evidence that interventions for newly diagnosed diabetes had a moderate benefit in reducing all-cause mortality, diabetes-related mortality, and risk of myocardial infarction after 10–20 years of intervention.
It was also found that preventive interventions, in particular lifestyle interventions, in persons identified as having prediabetes had a moderate benefit in reducing the progression to type 2 diabetes, as well as reducing other cardiovascular disease (CVD) risk factors such as blood pressure and lipid levels. Other preventive interventions are also effective in reducing the progression to type 2 diabetes without necessarily reducing other CVD risk factors.
Upon completion of their assessment, the USPSTF concluded with moderate certainty that screening for prediabetes and type 2 diabetes and offering or referring patients with prediabetes to effective preventive interventions has a moderate net benefit.
As of this writing, the American Diabetes Association currently recommends universal screening for prediabetes and type 2 diabetes for all adults age 45 years or older, regardless of risk factors, and screening overweight or obese adults with one or more risk factors regardless of age.
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.