The US Preventive Services Task Force (Task Force) has published a final B grade recommendation statement on screening for prediabetes and type 2 diabetes. The Task Force recommends screening adults between ages 35 to 70 years old with overweight or obesity for prediabetes and diabetes. Clinicians should offer or refer people with prediabetes to preventive interventions.
"Clinicians can prevent serious health complications by screening adults with overweight or obesity for prediabetes and diabetes," said Task Force member, Dr Chien-Wen Tseng. "With appropriate screening, diabetes can be detected and treated earlier to improve overall health."
The Task Force’s final recommendation statement and corresponding evidence summary, ‘Screening for Prediabetes and Type 2 Diabetes - US Preventive Services Task Force Recommendation Statement’, have been published online in the Journal of the American Medical Association.
For these latest recommendations - an update from its 2015 recommendations - 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. This review focused on direct evidence on the benefits and harms of screening for prediabetes and type 2 diabetes and the benefits and harms of interventions (such as behavioural counselling focused on diet, physical activity, or both, or pharmacotherapy for glycaemic, blood pressure, or lipid control, compared with no treatment or usual care) for screen-detected prediabetes and type 2 diabetes or recently diagnosed type 2 diabetes. The review also looked at the evidence on the effectiveness of interventions for prediabetes to delay or prevent progression to type 2 diabetes.
The USPSTF found two randomised clinical trials, the Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care (ADDITION)–Cambridge (n=20,184 participants) and the Ely study (n=4936 participants), that evaluated the effect of screening for diabetes on health outcomes.
ADDITION-Cambridge was a cluster randomised trial that randomly assigned practices to no screening, screening followed by intensive treatment of screen-detected diabetes (HbA1c target <7.0%, blood pressure target ≤135/85 mm Hg, and cholesterol targets, and low-dose aspirin use unless contraindicated), or screening followed by routine care of screen-detected diabetes.
In the Ely study, the treatment of persons with screen-detected diabetes was managed by primary care clinicians as they deemed appropriate. Neither trial found a reduction in all-cause or type-specific mortality with screening compared with no screening over approximately 10 years of follow-up, which notably may have been too short to detect an effect on health outcomes. Neither trial found statistically significant differences in cardiovascular events, quality of life, nephropathy, or neuropathy between screening and control groups, but data collection for these outcomes was limited to a minority of trial participants.
After reviewing the evidence, the USPSTF concluded 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. Therefore, the 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 (Grade B recommendation).
“Fortunately, there are interventions that are effective for preventing prediabetes from progressing to diabetes and in helping people with prediabetes improve their health,” added Task Force vice chair, Dr Michael Barry. “The Task Force encourages clinicians to screen adults over age 35 with overweight or obesity and work with them to determine if an intervention is needed.”
To access this paper, please click here