Use age alone for equitable diabetes screening, researchers say

Key takeaways:

• Screening for prediabetes and diabetes based on age is more equitable than screening based on weight.
• Making screening decisions based on age alone could lead to greater screening uptake.

Making screening decisions for diabetes based on age rather than weight is more equitable and could improve low screening rates, according to research published in the American Journal of Preventive Medicine.

The United States Preventive Services Task Force currently recommends screening people aged 35 to 70 years who have overweight or obesity, but previous research has indicated that Black, Hispanic and Asian Americans may be at risk for developing diabetes at lower weights and younger ages than their white counterparts.

“It might sound counterintuitive because we think of being overweight or obese as the primary cause of diabetes,” Matthew J. O’Brien, MD, MSc, an associate professor of medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine, said in a press release. “But if we make decisions about diabetes testing based on weight, we will miss some people from racial and ethnic minority groups who are developing prediabetes and diabetes at lower weights.”

Finding a screening approach that is equitable across the entire United States population is imperative, O’Brien added.

“Diabetes is a condition in which unacceptable racial and ethnic disparities persist,” O’Brien said in the release. “That’s why we need a screening approach that maximizes equity. If we can find everyone earlier, it helps us reduce these disparities and the bad outcomes that follow.”

O’Brien and colleagues collected nationally representative data from 3,243 adults without diabetes from January 2017 to March 2020. The screening eligibility was based on measured BMI and age, and they defined prediabetes and diabetes by fasting plasma glucose greater than or equal to 100 mg/dL or hemoglobin A1c greater than or equal to 5.7%. They then examined the sensitivity, predictive values and specificity of alternative screening criteria overall and by ethnicity and race.

Compared with the USPSTF’s 2015 criteria, which recommended to begin screening people with overweight or obesity at age 40 years, the researchers reported that the USPSTF’s 2021 screening criteria was able to identify more people with diabetes and prediabetes across all ethnic and racial groups. However, screening everyone aged 35 to 70 years performed most similarly by ethnicity and race, which they wrote could improve the early detection of diabetes and prediabetes among underrepresented populations.

Compared with the 2015 criteria, the 2021 criteria exhibited lower specificity — 69.3% (95% CI, 65.7-72.2) vs. 76.4% (95% CI, 73.3-79.2) — and marginally higher sensitivity —58.6% (95% CI, 55.5-61.6) vs. 52.9% (95% CI, 49.7-56) — both overall and within each ethnic and racial group.

Notably, screening at lower age and BMI thresholds led to even greater sensitivity and lower specificity, particularly among Asian, Black and Hispanic adults.

“Our findings illustrate that screening all adults aged 35 to 70 years, regardless of weight or body mass index, performs equitably across all racial and ethnic groups,” O’Brien said in the release.

He also noted in the release that research has indicated that just 50% of eligible adults are tested for diabetes and prediabetes, and that making screening decisions based on age alone is easier for physicians to implement, which could lead to greater uptake of this screening approach.

“There are many ways to nudge patients and providers to complete this testing, which should be the focus of future research,” he said in the release.

References:

• OBrien MJ, et al. Am J Prev Med. 2023;doi:10.1016/j.amepre.2023.01.007.
• Use age, not weight, to screen for diabetes. https://www.eurekalert.org/news-releases/983685. Published March 24, 2023. Accessed March 30, 2023.