USPSTF Lowers Recommended T2D, Prediabetes Screening Age to 35 Years

Beginning at age 35, overweight adults should be screened for prediabetes and type 2 diabetes (T2D), according to new recommendations issued by the US Preventive Services Task Force (USPSTF).¹

Previous guidelines issued in 2015 recommended this measure for those aged 40 to 70 years with overweight or obesity. The new recommendation comes as data suggest that incidence of diabetes increases at age 35 compared with younger ages; at-risk individuals should be screened every 3 years from ages 35 to 70.

Under the Affordable Care Act, insurers must cover USPSTF-recommended screenings and preventive services without out-of-pocket costs to the insured, The New York Times reports.

Currently, an estimated 13% of US adults aged 18 and older have diabetes and 34.5% meet the criteria for prediabetes, CDC data show. However, of the individuals with diabetes, around 21% were unaware of the condition or did not report having it, and only 15% of those with prediabetes were informed they had this condition.

“Diabetes is the leading cause of kidney failure and new cases of blindness among adults in the US. It is also associated with increased risks of cardiovascular disease, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis and was estimated to be the seventh leading cause of death in the US in 2017,” USPSTF researchers wrote in the recommendation statement. The condition and its risk factors can also put individuals at greater risk of severe COVID-19 outcomes.

Overweight and obesity constitute the main risk factors for both T2D and prediabetes. It is estimated around 42% of US adults are obese, according to data from 2017-2018. Increased levels of glycated hemoglobin (A1C), older age, family history, and dietary and lifestyle factors are also risk factors for these conditions.

Although different definitions of prediabetes and the heterogeneity of the condition lead to varied estimates regarding the risk of progression to diabetes, experts noted screening asymptomatic individuals for T2D and prediabetes may allow for early detection, diagnosis, and treatment.

The new age of recommended screening is based on results of a systematic review.

The population included in the analysis included nonpregnant adults between the ages 35 and 70 seen in primary care settings with overweight or obesity (defined as a body mass index ≥25 and ≥30, respectively). All participants had no diabetes symptoms.

As disproportionately high incidence and prevalence of these conditions are seen among certain minority groups, researchers stressed the importance of screening vulnerable populations, adding that heightened risk groups may need to begin screening earlier than age 35.

“The prevalence of diabetes is higher among American Indian/Alaska Native (14.7%), Asian (9.2%), Hispanic/Latino (12.5%), and non-Hispanic Black (11.7%) persons than among non-Hispanic White (7.5%) persons,” the authors explained, while “a large body of evidence demonstrates strong associations between prevalence of diabetes and social factors such as socioeconomic status, food environment, and physical environment.”

In addition to lifestyle and diet modifications, previous research revealed that intensive glucose control with metformin decreased all-cause mortality and diabetes-related mortality among patients with newly diagnosed diabetes. Metformin is currently not indicated for preventing or delaying progression from prediabetes to T2D in the United States.

In some trials, patients screened for and diagnosed with diabetes reported short-term increases in anxiety at 6 weeks compared with those screened and not diagnosed.

Overall, more research is still needed in the following areas:

• The effects of screening on health outcomes in populations reflective of the prevalence of diabetes in the United States, particularly racial and ethnic groups that have a higher prevalence of diabetes than White persons
• The effects of lifestyle interventions and medical treatments for screen-detected prediabetes and diabetes on health outcomes over a longer follow-up period, particularly in populations reflective of the prevalence of diabetes
• How best to increase uptake of lifestyle interventions, especially among populations at highest risk for progression to diabetes and adverse health outcomes
• To better elucidate the optimal frequency of screening and the age at which to start and stop screening
• The natural history of prediabetes, including the identification of factors associated with risk of progression to diabetes or reversion to normoglycemia

“The USPSTF recommendations to act early and identify and prevent diabetes may have their greatest value if they can reach young and vulnerable adults through a more diverse range of effective options for prevention. For individuals identified with recently diagnosed diabetes, addressing barriers and expediting access to risk factor management is the clearest route to prevent complications,” wrote Edward W. Gregg, PhD, and Tannaz Moin, MD, MBA, MSHS, in an accompanying editorial.²

“However, the greatest transformation in diabetes-related outcomes can be achieved if the problem is viewed from a longer-term perspective, whereby success is measured throughout the process and not at the beginning or the end,” they concluded.

References

1. US Preventive Services Task Force. Screening for prediabetes and type 2 diabetes. JAMA. 2021;326(8):736-743. doi:10.1001/jama.2021.12531

2. Gregg EW, Moin T. New USPSTF recommendations for screening for prediabetes and type 2 diabetes. JAMA. 2021;326(8):701-703. doi:10.1001/jama.2021.12559