USPSTF makes ‘huge’ change to prediabetes, diabetes screening recommendations for adults

Kim Brunisholz, PhD, MST

The main difference with the new USPSTF screening guidelines for prediabetes and diabetes includes broadening the pool of patients who are now eligible for the blood test — it will now include those aged 35 to 70 years when the previous guideline started screening at age 40.

Because the population of patients that are screened for diabetes will be larger, this will likely change the results of my retrospective cohort study. However, the variation in screening rates across clinics will not change — we continue to see differences that cannot be explained by geography, patient or provider characteristics. Our job now is to understand why and where this variation exists, provide tools to make it easier to do what is right, and provide real-time data back to the providers and clinicians so that they can improve over time.

I believe our primary care providers at Intermountain Healthcare will be open to changing their practice. Our health care system is focused on providing value-based care — keeping people healthy and out of our hospitals. Now that the USPSTF has provided a “B” recommendation, commercial insurers will be required by law to cover the cost of this test for eligible individuals, making the blood test free-of-charge for the millions of Americans who subscribe through their employer for health insurance. For those who consider not following this guideline, I would ask each to think about their own patients and loved ones who have diabetes and what they deal with on a daily basis to manage their disease. Can we not say with certainty that we would be better off to prevent or delay this debilitating disease before known complications such as heart attacks, dialysis and amputations begin? The data show that 25% of those with prediabetes will convert to diabetes in 3 to 5 years. This screening is an urgent need for our patients — one that now can be identified starting at age 35 years old by just having your blood tested every 3 years.

Reference: Brunisholz KD, et al. J Healthc Qual. 2021;doi:10.1097/JHQ.0000000000000281.

Matthew J. O'Brien, MD

I applaud the USPSTF for recommending a lower age to begin diabetes and prediabetes screening. A large body of prior research has found that racial/ethnic minorities develop diabetes at younger ages than whites. By lowering the screening age from 40 to 35 years, this will allow health care providers to identify patients with diabetes and prediabetes earlier.

Our research in community health centers, which are federally funded safety-net clinics, found that 13% of white patients developed prediabetes or diabetes before age 40. This proportion who developed prediabetes or diabetes before age 40 was much higher among Black and Latinx patients (25% and 31%, respectively). These data demonstrate the potential impact that lowering the screening age could have on reducing observed racial/ethnic disparities in diabetes by identifying cases and offering treatment earlier.

There are always numerous challenges to implementing preventive service recommendations. First and foremost, it is difficult for primary care physicians to remember the age ranges for ordering specific preventive services, which differ among the individual services that USPSTF recommends.

Second, in speaking with many other primary care physicians about diabetes screening, I have found that many are already screening patients from high-risk groups (eg, racial/ethnic minorities, with obesity and related comorbidities) before age 40 years. This is especially the case in settings that serve high proportions of at-risk patients. So, in some ways, this new recommendation from USPSTF is catching up with existing practice patterns and may be less widely followed in primary care clinics that serve a lower proportion of at-risk patients.