On Oct. 27, the U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement(www.uspreventiveservicestaskforce.org) that calls for adults at increased risk for type 2 diabetes to be screened to detect abnormal blood glucose levels or diabetes. This is a grade "B" recommendation.(www.uspreventiveservicestaskforce.org)
Specifically, the task force recommends screening for abnormal blood glucose in adults 40-70 who are overweight or obese. Furthermore, said the group, physicians should offer patients in whom abnormal blood glucose levels are detected intensive behavioral counseling interventions or refer them, if necessary, to promote a healthful diet and physical activity.
"Diabetes is a leading cause of heart attacks and strokes," said USPSTF member Michael Pignone, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "The good news is, we can identify people at risk and help them make lifestyle changes that may ultimately prevent or delay complications associated with this serious illness."
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 (i.e., African Americans, American Indians or Alaska Natives, Asian Americans, Hispanics or Latinos, and Native Hawaiians or Pacific Islanders).
This final statement updates a 2008 USPSTF recommendation(www.uspreventiveservicestaskforce.org) calling for diabetes screening in asymptomatic adults with hypertension (sustained blood pressure of greater than 135/80 mm Hg), which also was a B recommendation. In addition, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening in asymptomatic adults without hypertension.
At the time, the AAFP's recommendations on screening for diabetes mirrored those of the task force.
Since the previous recommendation statement 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). The groups also found limited evidence from longer-term studies that suggested such interventions may actually improve outcomes.
Lifestyle modifications such as improved nutrition, healthy eating behaviors and increased physical activity are, in fact, 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 to show that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity.
"Losing weight reduces the chances of developing diabetes, which is why our recommendation focuses on diet and exercise," said task force member William Phillips, M.D., M.P.H., in the release. "Patients who have abnormal blood sugar levels can be referred to programs that help them eat a more healthful diet and exercise more often."
The AAFP is reviewing the final USPSTF evidence(www.uspreventiveservicestaskforce.org) and will update its own recommendations on type 2 diabetes screening in the future.
Related AAFP News Coverage
Obesity Care Model Calls for Primary Care, Public Health Integration