USPSTF expands screening recommendation for prediabetes, type-2 diabetes to adults aged 35-plus

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The USPSTF issued recommends that clinicians screen for prediabetes and type-2 diabetes in overweight or obese adults starting at age 35

The United States Preventive Services Task Force (USPSTF) has issued an updated recommendation statement suggesting clinicians screen for prediabetes and type-2 diabetes in overweight or obese adults aged 35–70 years—capturing patients five years earlier than the previous advisory from 2015.

The B-classed recommendation means the USPSTF believes there is high certainty the net benefit from the offer or referral for effective preventive interventions is moderate “or there is moderate certainty that the net benefit is moderate to substantial.”

The update is based on a systematic review aimed at evaluating screening for prediabetes and type-2 diabetes in asymptomatic, non-pregnant adults as well as preventive interventions for those with prediabetes.

“Based on data suggesting that the incidence of diabetes increases at age 35 years compared with younger ages and on the evidence for the benefits of interventions for newly diagnosed diabetes, the USPSTF has decreased the age at which to begin screening to 35 years,” the statement reads.

Furthermore, evidence on the optimal screening interval for adults with an initial normal glucose test result is limited, with cohort and modeling studies suggesting that “screening every three years may be a reasonable approach for adults with normal blood glucose levels.”

USPSTF members led by Karina W. Davidson, PhD, of Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, authored the recommendation, which was recently published in the Journal of the American Medical Association (JAMA).

“Screening asymptomatic adults for prediabetes and type-2 diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes,” the authors wrote.

The update replaces the 2015 USPSTF recommendation statement, which suggested screening for abnormal blood glucose levels as part of cardiovascular risk assessment in overweight or obese adults aged 40 to 70 years. The classifications of overweight and obese are defined as a body mass index (BMI) of ≥25 and ≥30, respectively.

An estimated 13% of all U.S. adults aged 18 years or older have diabetes, with 34.5% meeting criteria for prediabetes. The prevalence of both prediabetes and diabetes are higher in older adults, the USPSTF authors add. “Estimates of the risk of progression from prediabetes to diabetes vary widely, perhaps because of differences in the definition of prediabetes or the heterogeneity of prediabetes.”

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