USPSTF Seeks Public Input on Screening Guidelines

The US Preventive Services Task Force (USPSTF) recently released a draft version of screening recommendations for abnormal glucose and type 2 diabetes mellitus in adults who are at increased risk for diabetes, and is seeking public input on the suggestions.

The recommendations note that in 2012 an estimated 86 million Americans over the age of 20 had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), while 29 million people in the country were diagnosed with diabetes. That does not include an estimated 8 million Americans who had undiagnosed diabetes. “The prevalence of diabetes in the United States has been increasing in the past 15 years, from 5% in 1995 to 9% in 2012,” the authors noted.

Risk factors for IFG, IGT, and/or diabetes include being over the age of 45, overweight or obesity, and a family history (first-degree relative) of diabetes. Other groups at risk include women who have been diagnosed with gestational diabetes or polycystic ovarian syndrome, and certain minorities including African Americans, American or Alaskan Natives, Asian Americans, and Hispanic or Latino people.

In the report the group found “inadequate direct evidence that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity.” They did however note that they “found adequate evidence that measuring blood glucose in adults at increased risk for diabetes and treating those who have IFG or IGT with intensive lifestyle interventions has a moderate benefit in decreasing the risk for progression to diabetes.”

Lifestyle interventions included exercise and dietary changes, which the USPSTF called, “the first line of therapy” for the prevention of the diagnoses in the report.

The USPSTF found adequate evidence that “intensive lifestyle modifications result in a lower incidence of diabetes, cardiovascular mortality and all-cause mortality.”

One of the questions raised about screening for these conditions is the mental toll it can take on patients in addition to the physical issues they are dealing with. In its report the USPSTF said while they were worth considering, there were bigger issues involved.

“The USPSTF found that measuring blood glucose is associated with short-term anxiety but not long-term psychological harms,” they said. They also concluded that the potential harms that could come from the proposed lifestyle changes are not enough to overcome their inherent benefits.

There are a variety of tests that can be done to determine a patient’s health in relation to these conditions including checking hemoglobin A1c which does not require fasting prior to testing. This is in contrast to fasting plasma glucose or oral glucose tolerant tests. The USPSTF said studies have shown that getting tested in 3-year intervals “may be a reasonable approach for adults at low risk for normal blood glucose levels.” Higher risk people, they said, may want to be tested on a yearly basis.

Even with all the evidence collected the recommendation from the group was not overwhelming in its decisiveness.

“The USPSTF concludes with moderate certainty that measuring blood glucose to detect IFG, IGT, or diabetes has a moderate net benefit in adults at increased risk for diabetes.”

Those wishing to make comments on the recommendations are encouraged to do so here.