Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients

Abstract

BackgroundIn 2015, the United States Preventive Services Task Force (USPSTF) recommended targeted screening for prediabetes and diabetes (dysglycemia) in adults who are aged 40 to 70 y old and overweight or obese. Given increasing prevalence of dysglycemia at younger ages and lower body weight, particularly among racial/ethnic minorities, we sought to determine whether the current screening criteria may fail to identify some high-risk population subgroups.Methods and FindingsWe investigated the performance of the 2015 USPSTF screening recommendation in detecting dysglycemia among US community health center patients. A retrospective analysis of electronic health record (EHR) data from 50,515 adult primary care patients was conducted. Longitudinal EHR data were collected in six health centers in the Midwest and Southwest. Patients with a first office visit between 2008 and 2010 were identified and followed for up to 3 y through 2013. We excluded patients who had dysglycemia at baseline and those with fewer than two office visits during the follow-up period. The exposure of interest was eligibility for screening according to the 2015 USPSTF criteria. The primary outcome was development of dysglycemia during follow-up, determined by: (1) laboratory results (fasting/2-h postload/random glucose ≥ 100/140/200 mg/dL [5.55/7.77/11.10 mmol/L] or hemoglobin A1C ≥ 5.7% [39 mmol/mol]); (2) diagnosis codes for prediabetes or type 2 diabetes; or (3) antidiabetic medication order. At baseline, 18,846 (37.3%) participants were aged ≥40 y, 33,537 (66.4%) were overweight or obese, and 39,061 (77.3%) were racial/ethnic minorities (34.6% Black, 33.9% Hispanic/Latino, and 8.7% Other). Overall, 29,946 (59.3%) patients had a glycemic test within 3 y of follow-up, and 8,478 of them developed dysglycemia. Only 12,679 (25.1%) patients were eligible for screening according to the 2015 USPSTF criteria, which demonstrated the following sensitivity and specificity (95% CI): 45.0% (43.9%–46.1%) and 71.9% (71.3%–72.5%), respectively. Racial/ethnic minorities were significantly less likely to be eligible for screening yet had higher odds of developing dysglycemia than whites (odds ratio [95% CI]: Blacks 1.24 [1.09–1.40]; Hispanics 1.46 [1.30–1.64]; and Other 1.33 [1.16–1.54]). In addition, the screening criteria had lower sensitivity in all racial/ethnic minority groups compared to whites. Limitations of this study include the ascertainment of dysglycemia only among patients with available test results and findings that may not be generalizable at the population level.ConclusionsTargeted diabetes screening based on new USPSTF criteria may detect approximately half of adult community health center patients with undiagnosed dysglycemia and proportionately fewer racial/ethnic minorities than whites. Future research is needed to estimate the performance of these screening criteria in population-based samples.

Cost‐effectiveness of diabetes screening initiated through a dental visit

“…In terms of cost-effectiveness, Table 1 23 Nevertheless, this screening approach only identifies about half of the persons in community health centres with undiagnosed dysglycemia (prediabetes and diabetes). 24 Diabetes mellitus is recognized as one of the great health challenges of the 21st century. 25 Early identification of T2DM (before the onset of clinical symptoms) or prediabetes can, with appropriate follow-up treatment, improve clinical outcomes.…”

“…A 3‐years testing interval was suggested . Nevertheless, this screening approach only identifies about half of the persons in community health centres with undiagnosed dysglycemia (prediabetes and diabetes) …”

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin

“…The authors did not assess impaired fasting glucose because oral glucose tolerance tests are burdensome and unlikely to be performed in real-world diabetes prevention efforts, as evidenced by their low uptake in routine clinical practice. 27,38 …”

Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes

“…This analysis of the limited criteria used clinical data from community health centers, reporting a sensitivity of 45.0% and a specificity of 71.9%. 26 Despite studying a clinical This column displays the absolute difference between the proportion of adults who would be eligible for screening by the expanded criteria vs. the limited criteria within strata of categorical participant characteristics. N/A is listed in cells where the difference in screening eligibility cannot be determined e Self-reported history of gestational diabetes and polycystic ovarian syndrome was assessed among female participants only f Overweight/obesity status was determined based on BMI ≥ 25 kg/m 2 for all racial/ethnic groups.…”