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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

 

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What works in diabetes health care? Check out PubMed Health for evidence based information.

What is Clinical Effectiveness?

About Clinical Effectiveness Research

Clinical effectiveness research finds answers to the question “What works?” in medical and health care.

“Working” is a real health benefit – like symptom relief, quicker recovery, or longer life. To find out if something really works, all important effects need to be studied. That means possible harms as well as possible benefits.

Clinical or health effects are sometimes called patient-relevant outcomes.

How do researchers get from an idea to proof of clinical effectiveness?

Ideas about what could work might come from laboratory tests. There might be animal testing. Studies observing patients also generate important knowledge and theories.

But all these types of research cannot provide definite proof that a particular treatment works. Many other factors could be having an impact at the same time as treatment. People often improve with or without treatment, too.

Putting ideas, theories, and beliefs to the test

Testing clinical effectiveness in people requires experiments that can single out the true effects of specific actions. That is why the possible effects of treatments and prevention methods need to be studied in clinical trials.

One trial is rarely enough to provide definite answers. Later trials sometimes confirm early results – and sometimes come up with conflicting results. So researchers search for, and then analyze, all the trials that have studied particular questions. This type of research is called a systematic review. It can be used to look for studies other than trials as well, and address other questions – like, “What causes this disease?”

Definite answers and areas of uncertainty

Systematic reviews can show which treatments and prevention methods have been proven to work – and what remains unknown. Being clear about what is certain or uncertain is an important part of informed decision-making.

Systematic reviews are the basis for what is often called evidence-based medicine or health care. And they are important for pointing to areas where more research is needed.

Other names for this kind of research are “evidence syntheses”, “comparative effectiveness reviews”, and “health technology assessments”.
By PubMed Health, reviewed 27 October 2015