This article is more than 5 years old. Information may no longer be current.
USPSTF criteria fail to identify almost half of adults with prediabetes, diabetes
Click Here to Manage Email Alerts
Clinicians who followed the U.S. Preventive Services Task Force 2015 screening criteria for diabetes missed almost half of the adults who had prediabetes or diabetes and not been previously diagnosed, according to findings recently published in the Journal of General Internal Medicine.
Matthew J. O’Brien, MD, MSc , of the department of medicine at the Northwestern University Feinberg School of Medicine, and colleagues analyzed data from 3,643 respondents of the National Health and Nutrition Examination 2011 to 2014 Survey who had not been diagnosed with diabetes. These respondents had their HbA1c, fasting plasma glucose and 2-h plasma glucose measured.
Researchers found that 49.7% of the patients had prediabetes or diabetes. Screening based on the “limited” criteria — based on patients being aged 40 to 70 years and being overweight or obese — showed sensitivity of 47.3% (95% CI, 44.7-50) and specificity of 71.4% (95% CI, 67.375.2). In addition, the “expanded” criteria — those with the limited criteria and at least one other risk factor, such as a family history of diabetes, history of polycystic ovary syndrome or gestational diabetes and/or nonwhite ethnicity — produced higher sensitivity 76.8% (95% CI, 73.5-79.8) and lower specificity 33.8% (95% CI, 30.1-37.7%).
“We were not particularly surprised by the findings because we know that there are many adults with prediabetes and diabetes who fall outside the age and weight ranges proposed here for screening. This is particularly an issue for Asians, who develop diabetes at lower body weights than other racial/ethnic groups,” O’Brien told Healio Family Medicine in an interview.
“According to our analysis, only 30% of Asians with prediabetes or diabetes would be screened according to this guideline. African-Americans and Latinos develop diabetes at younger ages than whites, making these groups also more likely to be missed by these screening criteria,” O’Brien said.
He noted the study is the first that looked into how the full 2015 USPSTF dysglycemia screening recommendations fared in a nationally representative sample of adults in the U.S. without a diabetes diagnosis, and had several suggestions for clinicians based on the findings.
“Primary care providers should screen for diabetes based on a more expansive set of risk factors for diabetes that are well established such as those by the American Diabetes Association, CDC or the ‘expanded’ set of risk factors proposed by USPSTF [described in the study]. This is in line with the recommendations from other expert groups, including the American Diabetes Association,” he said.
“PCPs should talk to their patients about the many factors that put them at risk for diabetes,” O’Brien continued. “They should also discuss with patients the risks and benefits of screening. Because the risks are minimal, providers should emphasize the benefits of preventing or treating diabetes earlier for patients whose screening tests are positive.”
Currently, the American Diabetes Association lists high blood glucose and BP levels; unhealthy cholesterol levels; and having gestational diabetes as some of the risk factors for type 2 diabetes; the CDC identifies being prediabetic; overweight; aged 45 years or older; having a sister, brother or parent with type 2 diabetes; conducting physical activity less than three times a week; having had gestational diabetes; giving birth to an infant weighing more than nine pounds; or being Hispanic/Latino American, African American, American Indian, or Alaska Native as risk factors for a type 2 diabetes diagnosis.
In addition, the USPSTF states on its website that “modifiable risk factors for abnormal glucose metabolism (manifested as either diabetes or abnormal glucose levels below the threshold for diabetes) include overweight and obesity or a high percentage of abdominal fat, physical inactivity, and smoking. Abnormal glucose metabolism is also frequently associated with other cardiovascular risk factors, such as hyperlipidemia and hypertension.” – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.
References:
CDC.gov. Diabetes Home Page. https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed June 7, 2018.
Diabetes.org. Lower Your Risk. http://www.diabetes.org/are-you-at-risk/lower-your-risk/ Accessed June 7, 2018.
USPreventiveServicesTaskForce.org. Final Recommendation Statement: Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes#Pod5. Accessed June 7, 2018.
Perspective
Back to Top
Arch G. Mainous III, PhD
The best tests are those that have high sensitivity, and high specificity. Though O’Brien and colleagues’ findings are not near 100% in each of these components, their results are not surprising but still useful. They examined the USPSTF general, “limited” guidelines and guidelines that take into account a variety of different additional variables (“expanded”). Personally, I think that the general, “limited” criteria that is outlined in this study is useful in determining which patients are at most risk for diabetes, even if it leads to more screenings, since tests with low specificity could lead to false positives. A primary concern of many providers, particularly around prediabetes, is medicalizing a condition that they may not feel is actually a disease. So, false positives do matter.
With some reports suggesting one out of every three people in the U.S. has prediabetes and with 90% of these people not knowing it, thus risking progression to full-blown diabetes, the main point I would take away from O’Brien’s study is that screenings must occur and that we pay attention to their screening recommendations. The goal of the USPSTF diabetes screenings is to promote earlier identification of the disease, predict prediabetes and perhaps get patients on regimens that could potentially get their glycemic levels back to normal.
While there are many things on a primary care physicians’ plate, using the USPSTF guidelines to screen for diabetes needs to be high on their priority list when they meet with patients. Diabetes is a chronic disease that a lot of people have, that costs both the patient and the health care system a lot of money. But if we can get people when they are prediabetic — and that is possible when we follow the USPSTF guidelines — then we can do something to bring the costs associated with the disease down for both the patient and health care system before their condition and costs spiral out of control.
Click Here to Manage Email Alerts