April 14, 2018  

Standards of Medical Care in Diabetes: 2018

Criteria guiding the medical community for screening patients for diabetes can vary based on the professional group making the recommendations.  For example, the screening guidelines by the United States Preventive Service Task Force (2015) is less stringent that the screening guidelines by the American Diabetes Association (2018).

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 a recent study published in Public Library of Science (PLOS)  found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.  This study suggests that the USPSTF widely accepted screening guidelines miss identifying many patients with diabetes and prediabetes.

The American Diabetes Association (ADA) recommends testing all adults beginning at age 45 years, regardless of weight, and all adults without symptoms of diabetes at any age if they are overweight or obese and have one or more additional risk factors for diabetes.  This screening recommendation was revised by the ADA for the purpose of clarifying the relationship between age, BMI, and risk for type 2 diabetes and prediabetes.

1. Testing should be considered in all adults who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and have additional risk factors:

  • Physical inactivity

  • First-degree relative with diabetes

  • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)

  • Women who delivered a baby weighing >9 lb or were diagnosed with GDM

  • Hypertension (≥140/90 mmHg or on therapy for hypertension)

  • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)

  • Women with polycystic ovary syndrome

  • A1C ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing

  • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)

  • History of CVD
2. For all patients, testing should begin at age 45 years.
3. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.
References:
American Diabetes Association. (2018). Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers. Clinical diabetes: a publication of the American Diabetes Association, 34(1), 3.
O’Brien, M. J., Lee, J. Y., Carnethon, M. R., Ackermann, R. T., Vargas, M. C., Hamilton, A., … & Buchanan, D. R. (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.  Retrieved from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002074

 

About Kim Warlick

I am a Diabetes Clinical Nurse Specialist and Certified Diabetes Educator. Having been a nurse for over 35 years, my passion is to help people who want to know more about how to prevent or manage their diabetes. Diabetes Self Management Education (DSME) is 95% of diabetes control and may be a covered benefit with your insurance provider. Follow my professional website and blog to find information and links to learn more about diabetes www.kimwarlickcnscde.com .

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