Screening for type 2 diabetes and pre-diabetes should start at age 35 for people who are considered overweight, rather than the age of 40 currently recommended, recommends a draft set of guidelines from the U.S. Preventive Services Task Force.
The update, prompted by the growing number of overweight or obese Americans, could result in millions more eligible for a blood test as part of regular medical examinations. The guidelines are specifically aimed at people who are overweight – a body mass index of 25 to 30 – or obese, with a BMI of 30 or more. Excess weight is an important risk factor for diabetes.
At least 31 million adults in the United States have type 2 diabetes, the seventh leading cause of death in the country, according to the Centers for Disease Control and Prevention. Diabetes can cause serious health problems, including heart disease, kidney failure, stroke, blindness and limb amputation. Pre-diabetes is a higher-than-normal blood sugar level that does not reach the limit for diabetes, but can eventually progress to the condition.
“We know that rates of pre-diabetes and diabetes are increasing in younger people,” said Dr. Chien-Wen Tseng, a member of the task force and professor of family medicine at the John A. Burns School of Medicine at the University of Hawaii . “Our main reason for decreasing age is to combine screening with where the problem is: if diabetes and pre-diabetes are occurring at a younger age, then we should be screening at a younger age.”
It is not yet known how many people with pre-diabetes will develop diabetes, Tseng said. “We know that there is a greater risk of developing diabetes, but we do not know exactly what the percentage is,” he added. “And we don’t know who is most likely to develop diabetes. Screening at an earlier age will tell us who should be monitored most often. “
The combined analysis of the task force of 23 previous studies, which included 12,915 participants with pre-diabetes, revealed that lifestyle changes reduced the risk of developing diabetes by 22 percent and the risk reduction did not depend on age, sex , race, ethnicity or BMI.
For most people, changes in lifestyle, including healthier eating habits and an increase in activity, can bring blood sugar under control, Tseng said.
The new guidelines are significant because early intervention can not only improve the control of diabetes, but also reduce the risk of chronic kidney disease and cardiovascular disease, said Dr. Emily Gallagher, assistant professor of medicine, endocrinology, diabetes and bone diseases at Icahn School of Medicine on Mount Sinai.
“Diabetes is the leading cause of kidney disease and blindness in the United States, and these are preventable diseases,” she said by email. “Unfortunately, people often still don’t know they have diabetes [until] they develop a complication, such as a heart attack or foot ulcer. “
It is also important that doctors consider screening earlier and with a lower BMI in certain minorities, including African Americans, Native Americans, Alaskan Natives, Asian Americans, Hispanics / Latinos, Native Hawaiians / Pacific Islanders, as well as people with a family history of diabetes, a history of gestational diabetes or polycystic ovarian disease, said Gallagher.
More adults with diabetes and prediabetes are likely to be identified with this reduced age limit, said Dr. Matthew O’Brien, associate professor of medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine. In addition, the new screening criteria are likely to result in more diagnoses of pre-diabetes and diabetes in black and Hispanic individuals, he said in an email.
A 2016 Northwestern University study, conducted at federally funded community health centers, found that 6.3% of white patients, 40 and under, developed diabetes within three years, he said. The proportion of black patients, 40 years old or younger, who developed diabetes during the same period was 11.1 percent, and 17.6 percent among Hispanic patients.
“Previous research has shown that awareness of having prediabetes and diabetes leads to improved lifestyle behaviors that help to control these conditions and prevent related complications,” said O’Brien.
