Diabetes Screening Recommendations

ENDOCRINOLOGY

USPSTF

The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.

If fasting blood glucose is impaired (100–125 mg/dL), the USPSTF recommends confirming the diagnosis of the abnormal glucose level soon by performing the same test on a different day.

 

American Diabetes Association (ADA)

> 45 years old
The ADA recommends screening all persons over the age of 45 with a fasting plasma glucose level or a 2-hour oral glucose tolerance test. Hemoglobin A1c is also an acceptable test.

<45 years old
Screening should be performed before age 45 for any individual with a BMI >25.0 kg/m2 who has any of the following additional risk factors:

    • physical inactivity
    • low HDL-cholesterol (<35 mg/dL) or high triglycerides (>250 mg/dL)
    • a first degree relative with diabetes mellitus
    • polycystic ovary syndrome or other insulin-resistance conditions (e.g., acanthosis nigricans)
    • delivery of an infant with a birth weight >9 lb, or a history of gestational diabetes
    • high-risk ethnicity (African American, Hispanic, Native American, Asian American, Pacific Islander)
    • a previous glucose tolerance test with elevated results or a hemoglobin A1c >5.7%
    • a history of vascular disease
    • hypertension
If screening results are normal, repeat testing should be done at least at 3-year intervals.
An OGTT is required to diagnose impaired glucose tolerance. The fasting plasma glucose level alone may miss about 30% of patients with isolated impaired glucose tolerance. If pharmacotherapy is used, document both impaired fasting glucose and impaired glucose tolerance.

OGTT=oral glucose tolerance test

 

References:

American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 2013;36(Suppl 1):S11-S66.
http://care.diabetesjournals.org/content/36/Supplement_1/S11.long

Ann Intern Med. 2015 Dec 1;163(11):861-8. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. https://www.ncbi.nlm.nih.gov/pubmed/26501513.

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