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Forget Weight, Focus on Age for Screening of Diabetes

Forget Weight, Focus on Age for Screening of Diabetes

by Dr. Hena Mariam on Mar 27 2023 5:02 PM
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Highlights:
  • 8.5 million people remain undiagnosed with diabetes
  • A new study has found that adults between the ages of 35 and 70 should be screened for diabetes, regardless of whether they are obese or not
  • Asian American adults with prediabetes and diabetes are the most likely to remain undetected
Diabetes is one of the most prevalent diseases today and screening for the disease is of utmost importance.
A recent Northwestern Medicine study says to focus on age, not weight, to capture the greatest number of people in all racial and ethnic groups with prediabetes and diabetes.

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Focus on Age, Not Weight for Diabetes Screening

Researchers found that screening all adults aged 35 to 70, regardless of weight, identified the greatest proportion of adults with prediabetes and diabetes in the U.S. This approach will also maximize the ability to diagnose prediabetes and diabetes across all racial and ethnic groups.

“All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans,” said lead investigator Dr. Matthew O’Brien, an associate professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

“It might sound counterintuitive because we think of being overweight or obese as the primary cause of diabetes,” O’Brien said.

The U.S. Preventive Services Task Force (USPSTF) currently recommends screening only individuals aged 35 to 70 who are overweight or obese.

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Racial and Ethnic Minorities at Risk of Being Undetected

“But if we make decisions about diabetes testing based on weight, we will miss some people from racial and ethnic minority groups who are developing prediabetes and diabetes at lower weights,” O’Brien said.

Diabetes diagnosis is frequently delayed in adults from racial and ethnic minority groups as compared to white adults. A delayed diagnosis means the disease is harder to control, and individuals are more likely to develop diabetes complications in the heart, eyes, and kidneys, while also having a higher risk of dying.

”Diabetes is a condition in which unacceptable racial and ethnic disparities persist,” O’Brien said. “That’s why we need a screening approach that maximizes equity. If we can find everyone earlier, it helps us reduce these disparities and the bad outcomes that follow.”

Nearly half of all adults in the United States have Type 2 diabetes or prediabetes, which is a major public health concern. Overall, 81% of adults with prediabetes are not aware of having the condition, and 23% of diabetes cases remain undiagnosed. Up to 70% of adults with prediabetes will eventually develop diabetes.

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Most Missed Group for Diabetes Screening is Asian Americans

Even at a normal weight, Asian American adults often develop diabetes and prediabetes. As a result, they are the most likely racial group to be missed in the recent 2021 guidelines for prediabetes and diabetes screening, reports the new study. An estimated 6 million Asian Americans have prediabetes or undiagnosed diabetes, according to a new study.

This is the first study to examine the health-equity implications of the current screening recommendations. Northwestern investigators examined the clinical performance of the 2021 USPSTF prediabetes and diabetes screening recommendation, as well as alternate age and Body Mass Index (BMI) cutoffs. The performance was assessed in the entire U.S. adult population, and separately by race and ethnicity.

The Task Force also recommended that practitioners pursue earlier screening among racial and ethnic groups at younger ages or with a lower BMI. However, these alternatives were not formally included in their recommendation. The current study evaluated several options for earlier screening, which provides evidence that can inform future changes to the Task Force’s guidelines.

“It’s imperative that we identify a screening approach that is equitable across the entire U.S. population,” O’Brien said. “Our findings illustrate that screening all adults aged 35 to 70 years, regardless of weight or body mass index, performs equitably across all racial and ethnic groups.”

Not Many Adults are Tested for Diabetes

Many studies have found that only half of the eligible adults, or fewer, are tested for prediabetes and diabetes.

“Making screening decisions based on age alone is also simpler for clinicians to implement, which may result in greater uptake of this screening approach,” said O’Brien.

“There are many ways to nudge patients and providers to complete this testing, which should be the focus of future research.”

Reference:
  1. Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity - (https://www.ajpmonline.org/article/S0749-3797(23)00006-5/fulltext)


Source-Medindia


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