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screening for diabetes mellitus

Recommendations differ depending upon organization. Indications: USPSTF - overweight adults age 35-70 years (BMI >= 25) as part of cardiovascular risk assessment [4] - asymptomatic adults with sustained blood pressure > 130/80 mm Hg. Endocrine Society - all pregnant women at 1st prenatal visit [9] American Diabetes Association - all persons every 3 years beginning at age 45 years - screening cost-effective when begun age 30-45 years & repeated every 3-5 years [8] - consider screening patients < 45 years if BMI >= 25 + - *additional risk factors - *1st degree relative with diabetes mellitus type 2 - ethnic risk: Hispanic, American Indian, African American, Asian American, Pacific Islander - inactivity - severe obesity - history of gestational diabetes - *delivery of large infant > 9 lbs (4.1 kg) - dyslipidemia - low HDL cholesterol (< 35 mg/dL) - high serum triglycerides (> 250 mg/dL) - hypertension (BP > 140/90 mm Hg) - polycystic ovary syndrome - acanthosis nigricans - impaired fasting glucose - history of impaired glucose tolerance test - hemoglobin A1c >= 5.7% [4] - history of cardiovascular disease - use of glucocorticoids or antipsychotics [4] US Preventive Services Task Force - age >= 35-45 years [4,14] - *adults at high risk for type 2 diabetes, defined as: - overweight or obese (35 years) [14] - *first-degree relative with diabetes [10] - history of gestational diabetes - history of polycystic ovary syndrome - high risk ethnicity (black, Native American, Latino. native Hawaiian or Pacific islander, Asian American) - screening every 3 years American Diabetes Association - screen Asian-Americans with BMI >= 23 [11] Any adult with cardiovascular disease, hypertension or dyslipidemia [4] Benefit/risk: - no mortality benefit within 10 years of screening for diabetes mellitus type 2 [10] - treatment of impaired fasting glucose or impaired glucose tolerance with lifestyle intervention associated with decreased mortality after 23 years [10] Laboratory: 1) fasting plasma glucose (< 110 mg/dL is normal*) 2) hemoglobin A1c [5] 3) oral glucose tolerance test (< 140 mg/dL at 2h is normal) * 100 mg/dL [3] Repeat testing every 3 years if normal. Repeat every 1-2 years for patients with prediabetes. Diagnostic criteria: - 8 hr fasting plasma glucose > 126 mg/dL on 2 separate occasions - HgbA1c of >= 6.5% - plasma glucose > 200 mg/dL 2 hr after 75 ng oral glucose tolerance test - random plasma glucose > 200 mg/dL with symptoms of hyperglycemia - 2 separate screening tests done simultaneously & both are abnormal Notes: - screening of all middle-age adults for type 2 diabetes does not lower 10 year mortality risk [6] - risk missing or overdiagnosing diabetes [12] - interventions such as lifestyle changes & metformin, with low adherence rates (<30%) & modest effects [12]

Related

diabetes mellitus diabetes mellitus type 2 (insulin-resistant) prediabetes

General

screening for endocrine disease

References

  1. Prescriber's Letter 9(4):19 2002
  2. Journal Watch 23(5):43, 2003 US Preventive Services Task Force, Ann Intern Med 138: (Feb 4) 2003 Harris R et al, Ann Intern Med 138:215 (Feb 4), 2003 http://www.ahrq.gov/clinic/3rduspstf/diabscr/
  3. Cohan P. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 17 American College of Physicians, Philadelphia 2006, 2009, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. Heianza Y et al. HbA1c 5 7-6 4% and impaired fasting plasma glucose for diagnosis of prediabetes and risk of progression to diabetes in Japan (TOPICS 3): A longitudinal cohort study. Lancet 2011 Jun 25; PMID: 21705064 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60472-8/fulltext
  6. Simmons RK et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): A cluster-randomised controlled trial. Lancet 2012 Oct 4; PMID: 23040422 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61422-6/fulltext
  7. Canadian Task Force on Preventive Health Care. Recommendations on screening for type 2 diabetes in adults. CMAJ 2012 Oct 16;184(15):1687-96. [51 references] PMID: 23073674 (corresponding NGC guideline withdrawn Dec 2017)
  8. Kahn R et al. Age at initiation and frequency of screening to detect type 2 diabetes: A cost-effectiveness analysis. Lancet 2010 Apr 17; 375:1365. PMID: 20356621
  9. Blumer I et al Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline. Endocrinology & Metabolism. Nov 1, 2013, 98(11):4227-4249 PMID: 24194617 http://jcem.endojournals.org/content/98/11/4227.abstract
  10. US Preventive Services Task Force (USPSTF) Draft Recommendation Statement Screening for Abnormal Glucose and Type 2 Diabetes Mellitus. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus - Selph S et al Screening for Type 2 Diabetes Mellitus: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 14 April 2015 PMID: 25867111 http://annals.org/article.aspx?articleid=2246121 - Siu AL for the U.S. Preventive Services Task Force Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 27 October 2015 PMID: 26501513 http://annals.org/article.aspx?articleid=2466368
  11. American Diabetes Association Standards of Medical Care in Diabetes-2015: Summary of Revisions Diabetes Care. Jan 2015. 38:S1-S2 http://care.diabetesjournals.org/content/38/Supplement_1
  12. Barry E et al Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta- analysis of screening tests and interventions. BMJ 2017;356:i6538 PMID: 28052845 http://www.bmj.com/content/356/bmj.i6538 - Waugh N Screen and intervene to prevent diabetes? BMJ 2017;356:i6800 PMID: 28052856 http://www.bmj.com/content/356/bmj.i6800
  13. NEJM Knowledge+ Question of the Week. July 30, 2019 https://knowledgeplus.nejm.org/question-of-week/868/ - Inzucchi SE. Clinical practice. Diagnosis of diabetes. N Engl J Med 2012 Aug 10; 367:542-550 PMID: 22873534 https://www.nejm.org/doi/full/10.1056/NEJMcp1103643
  14. US Preventive Services Task Force Screening for Prediabetes and Type 2 Diabetes. US Preventive Services Task Force Recommendation Statement JAMA. 2021;326(8):736-743 PMID: 34427594 https://jamanetwork.com/journals/jama/fullarticle/2783414 - Jonas DE, Crotty K, Yun JDY Screening for prediabetes and type 2 diabetes: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2021. Aug 24;326(8):744-760 PMID: 34427595 https://jamanetwork.com/journals/jama/fullarticle/2783415 - Grant RW, Gopalan A, Jaffe MG Updated USPSTF Screening Recommendations for Diabetes Identification of Abnormal Glucose Metabolism in Younger Adults. JAMA Intern Med. Published online August 24, 2021 PMID: 34427577 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2783521 - Gregg EW, Moin T. New USPSTF Recommendations for Screening for Prediabetes and Type 2 Diabetes. An Opportunity to Create National Momentum. JAMA. 2021;326(8):701-703 PMID: 34427620 https://jamanetwork.com/journals/jama/fullarticle/2783444