Screening for Prediabetes and Type 2 Diabetes

Abstract

ImportanceAccording to the Centers for Disease Control and Prevention 2020 National Diabetes Statistics Report, an estimated 13% of all US adults (18 years or older) have diabetes, and 34.5% meet criteria for prediabetes. 1 The prevalence of prediabetes and diabetes are higher in older adults. Of persons with diabetes, 21.4% were not aware of or did not report having diabetes, and only 15.3% of persons with prediabetes reported being told by a health profes-sional that they had this condition. 1 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. 2 A large cohort study of 77 107 persons with prediabetes reported that the risk of developing diabetes increased with increasing hemoglobin A 1c (HbA 1c ) level and with increasing body mass index (BMI). 3 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 (CVD), nonalcoholic fatty liver IMPORTANCE An estimated 13% of all US adults (18 years or older) have diabetes, and 34.5% meet criteria for prediabetes. The prevalences of prediabetes and diabetes are higher in older adults. 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. 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. Screening asymptomatic adults for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes.OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a systematic review to evaluate screening for prediabetes and type 2 diabetes in asymptomatic, nonpregnant adults and preventive interventions for those with prediabetes.POPULATION Nonpregnant adults aged 35 to 70 years seen in primary care settings who have overweight or obesity (defined as a body mass index Ն25 and Ն30, respectively) and no symptoms of diabetes.EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for prediabetes and type 2 diabetes and offering or referring patients with prediabetes to effective preventive interventions has a moderate net benefit. CONCLUSIONS AND RECOMMENDATIONThe USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions. (B recommendation)

The prediabetes conundrum: striking the balance between risk and resources

“…Type 2 diabetes is preventable (or at least delayable) through intensive lifestyle changes in individuals with prediabetes, with the caveat that most trials have included people with IGT, often in combination with overweight [ 38 ]. Interventions aimed both at individuals at high risk of type 2 diabetes and at whole populations are reportedly cost-effective with regard to preventing diabetes [ 39 ], though some have questioned the translatability of the individual-level prevention trials to real-world conditions [ 10 ].…”

“…The jury is still out when it comes to the ability of diabetes prevention programmes to prevent diabetes-related complications and other conditions associated with prediabetes [ 38 ]. We find it likely that such programmes can reduce the rate of these outcomes, but this will likely require lifelong support and, again, the NNT will be large if the target groups are people with prediabetes based on the current definitions.…”

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

“…APOs are a recognized risk-enhancing factors, and as such should be incorporated into counseling in combination with traditional atherosclerotic CVD risk assessment. 110 All individuals with overweight or obesity are recommended to be screened for diabetes at least every 3 years and for those with a history of GDM, diabetes screening is recommended every 1-3 years. 111,112…”

To Do One and To Get More: Part II. Diabetes and metabolic dysfunction-associated fatty liver diseases

“…22–24 Therefore, it is a long-term effort to achieve the aim as the normalized sugar levels and maintenance of sugar homeostasis to delay or stop hyperglycemia-related organ damages. 25,26 There are many strategies applicable to DM control, such as lifestyle modification, routine and continuous blood glucose monitoring, and pharmacological therapy (antidiabetic agents [ADA] and sugar-lowering drugs), 27–30 and all of them attempt to minimize DM-related adverse events (AEs) and maintain the quality of life, similar to the therapy for other troublesome diseases by multiple modality strategy. 31–33…”