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USPSTF screening criteria miss half of adults with diabetes, prediabetes
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Fifty-five percent of patients with prediabetes or diabetes may be misidentified with the use of the 2015 U.S. Preventive Services Task Force diabetes screening guidelines, according to study findings published in PLOS Medicine.
The 2015 U.S. Preventive Services Task Force (USPSTF) guidelines recommend screening for prediabetes and diabetes in adults aged 40 to 70 years with overweight or obesity by testing HbA1c, fasting plasma glucose or 2-hour postload glucose during a 75-g oral glucose tolerance test.
“These findings suggest that doctors should consider screening patients for diabetes who do not fall within the age- and weight-based criteria defined by this guideline,” Matthew J. O’Brien, MD, assistant professor in medicine, division of general internal medicine and geriatrics, Northwestern University Feinberg School of Medicine, told Endocrine Today. “However, if patients who do not meet these USPSTF criteria have a diabetes screening test, they may have to pay for it out-of-pocket.”
Matthew J. O'Brien
O’Brien and colleagues evaluated electronic health record data from U.S. community health centers on 50,515 adult primary care patients with a first office visit between 2008 and 2010. Participants were followed for up to 3 years until 2013.
Participants were mostly younger than 40 years (62.7%), with overweight or obesity (66.4%), nonwhite (77.3%), female (72.5%) and uninsured or publicly insured (74.3%) at baseline. One risk factor for diabetes was present in more than 95% of participants, but just 25.1% met USPSTF screening criteria.
Fifty-nine percent of participants underwent a screening test within 3 years of the index visit. Seventy-eight percent of eligible participants were screened, and 53.1% who were not eligible were also screened. Through follow-up, 8,478 participants developed dysglycemia based on available test results; 45% were eligible for screening through the USPSTF guidelines. Among participants with dysglycemia missed by USPSTF criteria, 77.7% were younger than 40 years and 29.3% had normal weight.
Compared with white participants, there were higher odds for dysglycemia among black participants (OR = 1.24; 95% CI, 1.09-1.4), Hispanic participants (OR = 1.46; 95% CI, 1.3-1.64) and patients of other ethnicities (OR = 1.33; 95% CI, 1.16-1.54). Compared with white participants, ethnic minority participants with dysglycemia were less likely to be identified by the USPSTF screening criteria.
“By missing a substantial proportion of adults with prediabetes and diabetes, this screening guideline may delay effective treatments to prevent or control diabetes,” O’Brien told Endocrine Today. “The fact that racial/ethnic minorities are less likely to be identified by the screening criteria than whites raises concern that implementing this guideline may contribute to racial/ethnic disparities in diabetes.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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