The American Diabetes Association Disappointed in Scope of New Screening Guidelines for Type 2 Diabetes And Pleased with Expansion of Lifestyle Interventions
October 26, 2015
The American Diabetes Association (Association) thanks the United States Preventive Services Task Force (USPSTF) for releasing a final recommendation for Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus that improves upon the previous guidelines released in 2008. However, the Association is tremendously disappointed that the new USPSTF recommendation falls short of the well-established screening guidelines of diabetes experts around the world, including those of the Association. The final guidelines also fall short of the USPSTF's own draft recommendation, released in October of 2014. Under the draft guidelines, which the Association strongly supported, screening would reach all of those at high risk for diabetes – providing the best approach to finding the 8.1 million Americans with undiagnosed diabetes and the approximately 76 million with undiagnosed prediabetes prior to the onset of devastating complications. In addition, this broader coverage is important because those included in the USPSTF recommendation will receive coverage for screening without cost-sharing through most health insurance plans, an important benefit which has been limited by the final recommendation.
The Association appreciates that the recommendation to screen for abnormal blood glucose in overweight and obese individuals ages 40-70 will identify many more patients with type 2 diabetes and prediabetes than the prior USPSTF recommendation, which listed only hypertension as a risk factor. Additionally, we are very pleased that the USPSTF recommendation recognizes the importance of lifestyle interventions in the prevention and management of diabetes. The recommendation states that clinicians should refer patients with abnormal blood glucose to intensive behavioral counseling interventions, which will allow individuals with prediabetes to take advantage of successful, evidence-based prevention programs, like the National Diabetes Prevention Program, without cost-sharing. This coverage is extremely important.
"Diabetes is a serious disease that can result in dangerous, life-threatening complications, including, but not limited to, cardiovascular disease," said Robert Ratner, MD, Chief Scientific & Medical Officer, American Diabetes Association. "Diabetes is also a leading cause of blindness and amputation, and is the only rising cause of end-stage kidney disease. Therefore, it is shocking that the USPSTF ignored the morbidity and mortality associated with diabetes itself and chose to view diabetes screening solely through a focus on cardiovascular disease risk. Diabetes screening should not just be one component of a cardiovascular disease assessment as it is in the USPSTF's recommendation."
The Association has long recognized the importance of multiple-risk factor based screening for type 2 diabetes. While the USPSTF acknowledged the importance of screening individuals with risk factors in its draft recommendation, it backtracked substantially in today's final recommendation. By recommending screening solely for overweight or obese adults ages 40-70, the USPSTF ignores the populations most highly impacted by undiagnosed diabetes – notably, in adults aged 20-44, the rate of undiagnosed diabetes is nearly 60 percent higher than in the adult population as a whole. Minority populations are at increased risk for type 2 diabetes, yet this final screening recommendation fails to recognize these high-risk populations. Moreover, the rates of undiagnosed diabetes are 61 percent higher in Asian Americans, 50 percent higher in Hispanic Americans and 33 percent higher in Black Americans when compared to non-Hispanic whites. If we fail to identify the disease in those at highest risk we cannot hope to stop the diabetes epidemic. While the USPSTF acknowledges in its Clinical Considerations that these populations might need earlier screening, the recommendation itself ignores them completely.
"In addition to the at-risk, minority populations that are not addressed in the new guidelines, the age bracket covered for screening does not encompass all who are at risk," Ratner continued. "Diabetes screening should not be limited to ages 40-70. This grossly ignores the evidence of the National Institutes of Health's Diabetes Prevention Program (DPP) that found individuals at high risk as young as age 25 are able to reduce their risk for type 2 diabetes. Moreover, there was no upper age limit in the DPP trial, and seniors had an even higher success rate with lifestyle intervention. Also of note, women with a history of gestational diabetes are at the highest risk of developing type 2 diabetes, with fifty percent developing type 2 diabetes within five years. Beginning screening at age 40 is too little too late for many of these women with a history of gestational diabetes. They may have had diabetes for 5-10 years by then."
About the American Diabetes Association
More than 30 million Americans have diabetes, and every 21 seconds another person is diagnosed with diabetes. The American Diabetes Association (Association) is the global authority on diabetes and since 1940 has been committed to its mission to prevent and cure diabetes and to improve the lives of all people affected by diabetes. To tackle this global public health crisis, the Association drives discovery in research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and provides support and advocacy for people living with diabetes, those at risk of developing diabetes and the health care professionals who serve them. For more information, please call the American Diabetes Association at 1-800-DIABETESS (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)