December 16, 2021, 9:40 a.m. News Staff — Earlier this year, in response to an outpouring of member comments, the AAFP began work on a project designed to make it easier for family physicians to access, review and share the clinical guidelines and related resources that help them give patients optimal care.
The first step in that project was the development of a COPD clinical guidance webpage in July. The Academy has now taken the next step and published a new clinical guidance page on diabetes that lets members find clinical recommendations, implementation tools, quality measures and educational materials for physicians in one location.
The new clinical guidance page organizes information into several categories.
The highlight of the page is “Screening for Diabetes in Adults,” an updated clinical recommendation developed by the AAFP and approved in November.
The AAFP’s recommendation is based on a final recommendation statement on screening for prediabetes and type 2 diabetes published by the U.S. Preventive Services Task Force in August.
It should be noted that the AAFP’s recommendation differs from the task force’s recommendation statement in some areas.
The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity, and also recommends that clinicians offer or refer patients with prediabetes to effective preventive interventions. In contrast, the AAFP has concluded that the evidence is insufficient to assess the benefits and harms of screening for type 2 diabetes in adults aged 35 to 39 years. The AAFP stated in its recommendation that most of the evidence presented in the task force’s evidence report looked at adults over age 40, and that there were no subgroup analyses that specifically examined screening at younger ages.
Moreover, the AAFP does not agree that there is evidence to support screening for prediabetes. In its recommendation, the AAFP stated that “the current evidence does not show improvement in long-term health outcomes for screening for prediabetes in adults who have obesity or overweight,” and that since screening for prediabetes is neither sensitive nor specific, it may result in false positives or false negatives.
Sarah Coles, M.D., chair of the Academy’s Commission on Health of the Public and Science and an assistant professor in the Department of Family, Community and Preventive Medicine at the University of Arizona College of Medicine – Phoenix Family Medicine Residency, told AAFP News why the Academy’s stance differed from that of the task force.
“The AAFP agrees with screening for diabetes in adults ages 40 to 70 who have obesity or overweight and screening pregnant persons for gestational diabetes at 24 weeks gestation or greater,” said Coles. “After careful review of the USPSTF evidence report, the AAFP disagreed with the USPSTF on a few key points.
“The AAFP felt that there is currently insufficient evidence to recommend screening adults who are 35 to 39 years old. There was very little data about individuals in this age group. Unlike people who are diagnosed with diabetes when presenting with symptoms, people who had screen-detected diabetes did not show improvements in important patient-oriented health outcomes, like mortality or cardiovascular events.
“The AAFP also does not agree that there is sufficient evidence to recommend screening for prediabetes,” Coles continued. “The best available evidence does not show any long-term health outcomes from screening and the harms have not been adequately studied. Stigma and labeling have the potential to worsen health outcomes.”
Recommendations for screening for gestational diabetes in individuals who are pregnant are also included in the update. The Academy supports the task force’s recommendations on screening in this population.
The new diabetes clinical guidance page is part of a long-term project to renovate the Clinical Recommendations section of AAFP.org. Additional clinical guidance pages are currently in development; when finalized, they will integrate clinical, implementation and education guidance to ensure standardized care for a number of specific conditions commonly seen in family medicine practices.
Members are welcome to provide feedback on the new pages or suggest other topics for guidance by emailing email@example.com. Members also are encouraged to bookmark the Clinical Recommendations index page to find the latest updates, and to visit AAFP News for more information as it becomes available.