Diabetes Q&A

USPSTF Screening Criteria Could Miss Half of Diabetes Cases

Existing recommendations for dysglycemia screening from the US Preventive Services Task Force (USPSTF) miss approximately half of US adults with prediabetes or undiagnosed diabetes, according to new findings.

The criteria, which were issued by the USPSTF in 2015, recommend screening for dysglycemia in adults aged 40 to 70 years with overweight or obesity.
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However, according to the authors of a new study, “screening other high-risk subgroups defined in the USPSTF recommendation would improve detection of dysglycemia and may reduce associated racial/ethnic disparities. “

The researchers arrived at this conclusion following a study of 3463 adults without diagnosed diabetes. All participants in the study underwent measurement of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2-h PG)

During the study, the researchers used expanded criteria to determine patients’ eligibility for dysglycemia screening. In the expanded criteria, eligible participants either met the limited criteria or had at least 1 of the following risk factors:

  • Family history of diabetes
  • History of gestational diabetes or polycystic ovarian syndrome (PCOS)
  • Non-white race/ethnicity

Results revealed that 49.7% of the US adult population without diagnosed diabetes had dysglycemia—defined as hemoglobin A1c of at least 5.7%, FPG of at least 100 mg/dL, and/or 2-h PG of at least 140 mg/dL.

Notably, screening with limited USPSTF criteria had a sensitivity of only 47.3% and a specificity of 71.4%, whereas the expanded criteria demonstrated a higher sensitivity (76.8%) but a lower specificity (33.8%).

The researchers noted that point estimates for the sensitivity of limited criteria were lower in all minority groups, with significantly different point estimates for Asian patients compared with non-Hispanic white patients (29.9% vs 49.8%).

—Christina Vogt

Reference:

O’Brien MJ, Bullard KM, Zhang Y, et al. Performance of the 2015 US Preventive Services Task Force screening criteria for prediabetes and undiagnosed diabetes [Published online April 12, 2018]. J General Intern Med. https://doi.org/10.1007/s11606-018-4436-4

 

SEE ALSO: Caring for High-Risk Diabetes Patients of African Descent (Podcast)

 

Dr Stephanie Chung, an assistant clinical investigator in the Section on Ethnicity and Health in the Diabetes, Endocrinology, and Obesity Branch of the National Institutes of Health, discusses her latest paper about managing diabetes in patients of African descent—a particularly high-risk group.

For more podcasts, click here.