Primary care physicians should screen all adults over age 45 for diabetes, according to new recommendations proposed last Monday by a government-sponsored panel of experts. The US Preventive Services Task Force, composed of primary care providers, bases its new advice on evidence suggesting that diagnosing elevated blood sugar levels before people develop full-blown diabetes can reduce their risk of getting the condition and also developing heart disease.
Evidence from several recent large clinical trials suggests that those who have moderately elevated blood sugar, a condition called prediabetes, detected on a routine blood test and treated through a diet and exercise program have a 47 percent reduced risk of developing diabetes over the next several years.
The Task Force’s previous recommendations from 2008 advised diabetes screening only for those with increased heart disease risk due to high blood pressure because studies were lacking to show benefits for screening the general population. “More evidence has emerged since then on the benefits of lifestyle interventions,” said Task Force member Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill School of Medicine. “Our feeling is that you need to have an effective intervention available for people that you screen.”
People who are overweight, have a family history of diabetes, or are African-American, Asian, or Latino likely need to be screened earlier than 45, the Task Force recommended, because they’re at higher diabetes risk. Women who have polycystic ovary syndrome or who developed gestational diabetes during pregnancy also fall into the high-risk category.
“We didn’t specify an age for screening those high-risk groups,” Pignone said. “That’s something patients should discuss with their doctors.” The group also didn’t advise how frequently adults should be screened.
Diabetes experts supported the new recommendations, which agree with the latest advice from other medical organizations.
Both the American Diabetes Association and the Centers for Disease Control and Prevention urge doctors to consider performing screening every three years in adults age 45 and older, especially for those who are overweight. Screening tests include a blood glucose test which requires fasting for eight hours beforehand, a glucose tolerance test which checks blood sugar both before and after drinking a sweetened beverage, or a blood test to measure the marker hemoglobin A1C, which measures average blood glucose for the past two to three months.
About 86 million American adults have elevated blood sugar levels, and an additional 29 million have diabetes, which is up from 26 million in 2010. But more than one-quarter of those with diabetes are unaware that they have the condition because they don’t recognize the symptoms, like frequent urination, weight loss, and fatigue, and aren’t getting screened, according to a 2014 CDC report.
Dr. Osama Hamdy, medical director of the obesity clinical program at Joslin Diabetes Center, said the Task Force’s guidelines, aimed at primary care physicians, will likely lead not just to earlier diabetes diagnoses but to a greater detection of high blood sugar levels at a point when diabetes can still be prevented.
“We need to focus on prevention rather than just treating a problem,” Hamdy said.
Doctors, however, need to do more in terms of prevention than simply telling patients to quit junk food and soda and increase their physical activity, Pignone said. “The type of prevention program found to be effective in studies we reviewed typically involved 16 educational sessions, access to a health coach, and achievement of 150 minutes of activity each week,” he said. “Primary care practices don’t usually have the resources” to get patients to make drastic lifestyle changes.
Most of the lifestyle intervention programs offered at Joslin, Hamdy said, are only covered by insurance companies once a patient has been diagnosed with diabetes — not for prevention.
“I hope this new recommendation will set the stage for reimbursements at an earlier stage when diabetes can be prevented,” he added.
In the meantime, the CDC offers a National Diabetes Prevention program that teaches nutrition and exercise classes at more than a dozen health centers and YMCAs in Massachusetts at little or no cost to participants.