US Government Diabetes Screening Guidelines Misses Out High-risk Patients

Including many African-Americans, Hispanics and those who are not overweight, more than half of people at high risk for diabetes are missed under current US screening guidelines, researchers said.

The government guidelines -- issued just //last year -- missed 55 percent of people with prediabetes or diabetes, said the study by Northwestern Medicine.

Screening for Diabetes - Test - Frequently Asked Questions
Diabetes screening is done using blood tests like fasting blood sugar and hemoglobin A1c levels. Diabetes affects 8.3% Americans and about 10% Indians.

‘Only half of African-American patients that developed abnormal blood glucose levels met the screening criteria, and 37 percent of Latino patients.’

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The 2015 guidelines, which were authored by the United States Preventive Service Task Force (USPSTF), recommend that people undergo screening for diabetes if they are aged 40 to 70 years old and are overweight or obese.

"We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites," said senior author Matthew O'Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine.

The findings, published in the journal PLOS Medicine, are based on electronic health record data from more than 50,000 adult patients at community health centers in the midwestern and southwestern United States between 2008 and 2013.

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The most common types of diabetes, Type 1 and Type 2 are polygenic meaning developing from multiple genes.

"Say I'm caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy," said O'Brien.

"She shouldn't be screened, according to the guidelines, but she's very likely to have either prediabetes or diabetes."

Gestational Diabetes About
The condition is not caused by a lack of insulin, but by the action of hormones produced during pregnancy that blocks the action of insulin.

The guidelines have cost implications for patients, too.

Under President Barack Obama's health care law, the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers.

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The diabetic diet most often recommended is high in dietary fiber (especially soluble fiber) and nutrients, but low in fat (especially saturated fat) and moderate in calories.

But if a patient does not meet the guidelines' criteria, he or she may have to pay out of pocket for a diabetes test.

Those who are missed early can go on to develop full blown diabetes or complications including heart attack or stroke.

"By reporting on the limited effectiveness of this screening program, this study raises concerns about the program's broad utility, particularly among racial and ethnic minority groups," said the report.

"Primary care providers may need to consider screening minority patients who are younger than 40 years old and have a normal weight."

Source-AFP