Clinicians should screen all asymptomatic obese adults between 40 and 70 years for abnormal blood glucose as part of a cardiovascular risk assessment, according to new recommendations from the United States Preventive Services Task Force (USPSTF) published in the Annals of Internal Medicine.
“The USPSTF concludes with moderate certainty that there is a modifiable net benefit to measuring blood glucose to detect IFG, IGT, or diabetes,” wrote Albert Siu, MSPH, of Mount Sinai Hospital, on behalf of the USPSTF.
National data estimates from 2012 show that approximately 86 million Americans have either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). An estimated 15% to 30% of those people are at risk of developing type 2 diabetes within 5 years if lifestyle changes are not implemented.
Glucose abnormalities can be detected by measuring either HbA1c or fasting plasma glucose, or through an oral glucose tolerance test. Any diagnosis of IFG, IGT, or type 2 diabetes should be confirmed via repeat testing using the same testing method.
Evidence suggests that behavioral interventions, consisting of multiple counseling sessions to promote a healthy diet and physical activity, ultimately result in more positive outcomes than pharmacologic interventions. Patients may be referred to community-based programs for these interventions. Adults with additional cardiovascular risk factors should also undergo intensive behavioral counseling interventions intended to promote cardiovascular disease prevention.
Persons who have a family history of diabetes, gestational diabetes, or polycystic ovarian syndrome, or who are members of certain racial and ethnic groups (African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may have an increased risk for diabetes at a younger age or at a lower body mass index. Clinicians are advised to consider screening earlier in persons with 1 or more of these characteristics.
- Siu AL. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventative Services Task Force Recommendation Statement. Ann Intern Med. 2015; doi: 10.7326/M15-2345