According to 2009-2012 National Health and Nutrition Examination Survey estimates, 12 percent of American adults age 20 or older have diabetes and another 37 percent have abnormal blood glucose levels that put them at increased risk for developing diabetes. Type 2 diabetes is overwhelmingly the most common type of diabetes in the United States.
To help physicians better diagnose patients with this condition, as well as delay or prevent development of the disease in those who are at risk, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation(www.uspreventiveservicestaskforce.org) on Oct. 7 that calls for screening adults at increased risk for type 2 diabetes to detect abnormal blood glucose levels or diabetes. This is a B recommendation.(www.uspreventiveservicestaskforce.org)
Risk factors for diabetes include being age 45 or older, being overweight or obese, and having a first-degree relative with diabetes. Women with a history of gestational diabetes or polycystic ovarian syndrome are also at increased risk, as are certain racial and ethnic minorities (e.g., African Americans, American Indians/Alaska Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders) compared with whites.
- On Oct. 7, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation calling for adults at increased risk for type 2 diabetes to be screened for the disease.
- Among risk factors for diabetes are being age 45 or older, being overweight or obese, and having a first-degree relative with the disease.
- The USPSTF is providing an opportunity for public comment on this draft recommendation statement and draft evidence review until Nov. 3.
"For people with abnormal blood sugar, changes in their lifestyle, such as eating healthier and exercising more often, can help prevent or delay the onset of type 2 diabetes," said USPSTF member Michael Pignone, M.D., M.P.H., in a news release(www.uspreventiveservicestaskforce.org) from the task force. "The best way to do that is to participate in a program that supports these behaviors. That's why we're recommending that people who are at increased risk be screened."
This draft recommendation statement updates a 2008 USPSTF recommendation(www.uspreventiveservicestaskforce.org) on screening for diabetes in asymptomatic adults with hypertension (sustained blood pressure of greater than 135/80 mm Hg), which also was a B recommendation. At that time, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening in adults without hypertension.
Since the previous recommendation was issued, six new intervention studies have shown consistent benefit from lifestyle modifications intended to prevent or delay progression to diabetes in those who have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and longer-term follow-up suggests that such interventions can improve clinical outcomes.
Lifestyle modifications (including improved nutrition, healthy eating behaviors and increased physical activity), in fact, are considered first-line therapy for preventing IFG, IGT and diabetes. The USPSTF found adequate evidence that intensive lifestyle modifications result in a lower incidence of diabetes, cardiovascular mortality and all-cause mortality.
However, although this new body of evidence led the USPSTF to conclude there is an overall moderate net benefit to measuring blood glucose levels in adults at increased risk for diabetes, the task force found inadequate direct evidence that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity.
The USPSTF is providing an opportunity for public comment(www.uspreventiveservicestaskforce.org) on this draft recommendation statement and draft evidence review(www.uspreventiveservicestaskforce.org) until Nov. 3.
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American Family Physician: AFP by Topic: Diabetes: Type 2