New diabetes screening recommendation misses more than half of high-risk patients

July 12, 2016, Northwestern University

The latest government guidelines doctors follow to determine if patients should be screened for diabetes missed 55 percent of high-risk individuals with prediabetes or diabetes, a new Northwestern Medicine study found.

The 2015 screening guidelines from the United States Preventive Service Task Force (USPSTF) recommend patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. But the study found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.

Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications. This is the first study to examine how the new USPSTF guidelines, issued in October, may perform in practice.

Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out of pocket.

"Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly," said study senior author Dr. Matthew O'Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes."

The study will be published in PLOS Medicine on July 12.

Fifty-four percent of white patients who developed dysglycemia fell within the screening guidelines, compared to only 50 percent of African-American patients and 37 percent of Latino patients, according to the study.

"Say I'm caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy. She shouldn't be screened, according to the guidelines, but she's very likely to have either prediabetes or diabetes," O'Brien said.

The study looked at electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.

O'Brien said the USPSTF is on the right track with their guidelines because they focus on the two risk factors—age and weight—that are most predictive of developing dysglycemia. However, physicians should be aware of this study's findings, so they can understand who may be missed by the USPSTF's criteria and decide whether to screen those patients, he said.

"We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites," O'Brien said.

With these findings, O'Brien said next steps are to decide what other factors should be taken into account when determining who is at risk for diabetes and to use electronic health records to automatically prompt providers to screen patients who have those risk factors.

Explore further: USPSTF: evidence lacking for pelvic screening examinations

More information: O'Brien MJ, Lee JY, Carnethon MR, Ackermann RT, Vargas MC, Hamilton A, et al. (2016) Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med 13(7): e1002074. DOI: 10.1371/journal.pmed.1002074

Related Stories

USPSTF: evidence lacking for pelvic screening examinations

June 29, 2016
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) has concluded that the current evidence is insufficient to weigh the balance of benefits and harms for screening pelvic examinations in asymptomatic, nonpregnant ...

USPSTF recommends CRC screening for 50- to 75-year-olds

October 6, 2015
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer (CRC) screening starting at age 50 years and continuing through age 75 years. These findings form the basis of a draft recommendation ...

USPSTF finds evidence lacking for sleep apnea screening

June 15, 2016
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) has found insufficient evidence for the benefit of obstructive sleep apnea (OSA) screening in asymptomatic populations. These findings form the basis of a draft ...

Screening for syphilis recommended for persons at increased risk of infection

June 7, 2016
The U.S. Preventive Services Task Force (USPSTF) has found convincing evidence that screening for syphilis infection in asymptomatic, nonpregnant persons at increased risk for infection provides substantial benefit. The report ...

USPSTF recommends depression screening for teens

September 8, 2015
(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents, but evidence is inadequate to assess screening tools for younger children. These findings ...

Doctors should screen teens for major depression, US task force says

February 9, 2016
(HealthDay)—Primary care doctors should screen all patients between 12 and 18 years of age for major depression, but not younger children, preventive health experts say.

Recommended for you

Does diabetes damage brain health?

December 14, 2018
(HealthDay)—Diabetes has been tied to a number of complications such as kidney disease, but new research has found that older people with type 2 diabetes can also have more difficulties with thinking and memory.

Researchers study abnormal blood glucose levels of discharged patients

December 14, 2018
University of Minnesota Medical School researchers decided to delve into an area where little data currently exists. They wanted to know what happens after these patients with abnormal blood glucose measurements are discharged? ...

Researchers zero in on potential therapeutic target for diabetes, associated diseases

December 14, 2018
A recent study led by researchers in Texas A&M University's department of nutrition and food science shows how a novel regulatory mechanism serves as an important biomarker for the development of diabetes, as well as a potential ...

Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes

December 11, 2018
Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes.

Millions of low-risk people with diabetes may be testing their blood sugar too often

December 10, 2018
For people with Type 2 diabetes, the task of testing their blood sugar with a fingertip prick and a drop of blood on a special strip of paper becomes part of everyday life.

Very low calorie diets trialled by NHS to tackle diabetes

December 7, 2018
Hundreds of thousands of people will receive NHS help to battle obesity and type 2 diabetes under radical action set out by Simon Stevens, Chief Executive of NHS England.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.