Clinical Preventive Service Recommendation
Grade: B recommendation
The AAFP recommends screening for gestational diabetes mellitus (GDM) in asymptomatic pregnant women after 24 weeks of gestation. (2014)
Grade: I recommendation
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for GDM in asymptomatic pregnant women before 24 weeks of gestation. (2014)
Grade: B recommendation
The AAFP recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity. (2015)
Clinical Consideration Summary
The AAFP agrees with the United States Preventive Services Task Force's rationale for screening for abnormal glucose in overweight or obese adults. Elevated body mass index and abnormal blood glucose are modifable risk factors for cardiovascular disease. Although the AAFP concludes there is currently inadequate evidence whether early detection of abnormal blood glucose or diabetes leads to improvements in mortality or cardiovascular morbidity, screening blood glucose measurement is consistent with AAFPs' recommendations for behavioral interventions in adults who are obese or are overweight with additional cardiovascular risk factors.
Glucose abnormalities can be detected by measuring HgbA1c, fasting plasma glucose, or oral glucose tolerance test. Abnormal results should be confirmed. Adults with confirmed impaired glucose tolerance should receive counseling on healthful diet and physical activity by trained providers who work directly with program participants for at least 3 months in order to delay development of diabetes(www.thecommunityguide.org).
There is limited evidence on the best rescreening intervals for adults with normal results, but screening every 3 years is a reasonable option.
These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.