Diabetes screening rates in the US are below ADA recommendations

Only about half of of the people the American Diabetes Association recommends should be screened for type 2 diabetes are being screened, according to a new study published in American Journal of Preventive Medicine. The study found that 53.2% of people over 45 who took part in the 2005–2010 National Health and Nutritional Examination (NHANES) and the 2006 national Health Interview Survey were screened for diabetes in the last three years.

The ADA recommends people should be screened at 3-year intervals beginning at age 45, particularly in those with BMI ≥25 kg/m2. Testing should be considered at a younger age or be carried out more frequently in individuals who are overweight and have other risk factors, including habitual physical inactivity, obesity, hypertension, and family history of diabetes. The ADA also recommends earlier screening for African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders.

The study found screening to be even less prevalent in minorities and those with lower socioeconomic status. "Public health efforts to address these deficiencies in screening are needed," the authors wrote. Study authors included Sarah Stark Casagrande, PhD; Catherine C. Cowie, PhD; and Saul M. Genuth, MD.

Overall, the prevalence of having had a blood test to screen for diabetes in the past three years in adults aged 20 or older was 43.6% in NHANES. The prevalence of having a blood test increased with age and was lower in men (37.9%) than women (48.7%); Hispanics (38.9%) or Mexican Americans (38.6%) than non-Hispanic whites (44.5%) or non-Hispanic blacks (46.3%); those with less than a high school education (40.5%) compared with college graduates (46.6%); and in adults with a family income <$20,000 (39.2%) compared with ≥$75,000 (47.1%) (p<0.001 for all). Adults without health insurance, without self-reported prediabetes, and those who did not see any type of doctor in the past year were less likely to have a diabetes screening test compared to their respective counterparts, according to the study.

"More emphasis on community screening programs and population-wide education programs would help increase the number of people who are screened for diabetes and would detect more cases," the authors wrote.

The president of health care and education at the American Diabetes Association Marjorie Cypress, PhD, told Health Behavior News Service, part of the Center for Advancing Health, that she wasn’t surprised by the study’s findings because she is seeing similar screening statistics. She explained various factors that play a part in screening underserved and high-risk populations. “Fear keeps some people from being screened. They’re afraid of what they may learn. Others only seek medical care when they are sick, and at that time they may not be screened for diabetes because the illness that brought them to a clinic is the priority at hand. Still others stay away from health care and screenings altogether because they don’t have health insurance, although that may be changing as more people gain coverage.”