USPSTF Lowers Age to Start Diabetes Screening in Overweight/Obese Adults

The U.S. Preventive Services Task Force (USPSTF) lowered its recommended age to start screening for type 2 diabetes and prediabetes in overweight and obese adults from 40 to 35.

The task force also stressed the importance of offering or referring individuals with prediabetes to preventive interventions, in a statement by Karina Davidson, PhD, of the Feinstein Institutes for Medical Research in New York City, and colleagues.

"Based on data suggesting that the incidence of diabetes increases at age 35 years compared with younger ages, and on the evidence for the benefits of interventions for newly diagnosed diabetes ... the USPSTF has decreased the age at which to begin screening," the authors wrote in JAMA.

The new guidance -- screening for prediabetes and diabetes in adults 35 to 70 years of age who are overweight or obese (B recommendation) -- is based on a systematic review of clinical trials. The USPSTF "concludes 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," the statement said.

The review found "convincing evidence" that interventions in people with prediabetes can reduce progression to type 2 diabetes and lower cardiovascular risk factors such as blood pressure and lipids. The review also found "adequate evidence" that interventions for newly diagnosed diabetes can reduce all-cause mortality, diabetes-related mortality, and risk of myocardial infarction, if continued for 10 to 20 years. The U.K. Prospective Diabetes Study, for example, reported such benefits after 20 years, but not at shorter follow-up, the task force statement said.

In a related editorial in JAMA Internal Medicine, Richard Grant, MD, of Kaiser Permanente Northern California in Oakland, and co-authors noted that the updated USPSTF recommendations are similar to the American Diabetes Association (ADA) 2021 Standards of Medical Care in Diabetes advice to screen all adults 45 and older for diabetes regardless of body-mass index (BMI), and to screen adults younger than 45 if they have a BMI of 25 or higher and at least one additional diabetes risk factor.

"Both the USPSTF and ADA recommendations highlight the increasing prevalence of abnormal glucose metabolism and diabetes in younger adults, especially among at-risk racial and ethnic groups," Grant and colleagues wrote. They added that a recent study based on National Health and Nutrition Examination Survey data, for example, found that one in four young adults ages 19 to 34 had abnormal glucose metabolism.

"Diabetes in the U.S. is clearly no longer a disease limited to middle-aged and older adults," Grant and colleagues said. "Lowering the age for screening may facilitate earlier recognition of diabetes, including in the racial and ethnic groups at highest risk, and holds out the promise of reducing long-term disparities in outcomes through weight loss, other lifestyle modification, and the timely initiation of medical treatment."

And in an editorial in JAMA, Edward Gregg, PhD, of the Imperial College London, and Tannaz Moin, MD, MBA, MSHS, of David Geffen School of Medicine at the University of California, Los Angeles, noted that the new USPSTF recommendations apply to a large proportion of the adult population. More than 40% will be eligible for screening under the new guidelines, and as many as one-third of those could meet criteria for a prevention program.

"In theory, strong implementation across the full chain of recommended actions could contribute to significant health benefits, ranging from a reduced incidence of diabetes to a reduction in diabetes-related complications," Gregg and Moin wrote.

However, one issue that needs to be addressed, they said, is the low rate of referral to prevention programs for adults with prediabetes. In the 2016-2017 National Health Interview Survey of 50,912 adults in the U.S., for example, only 5% of people diagnosed with prediabetes reported being referred to a diabetes prevention or weight loss program. Of those referred, just 40% reported actually participating.

Gregg and Moin noted that national, multi-component interventions including the CDC's National Diabetes Prevention Program and the English National Health Service Diabetes Prevention Programme, currently include hundreds of thousands of individuals.

These interventions "have shown encouraging program attendance and weight loss when referral occurs and programs are available. However, the U.S. enrollment represents less than 1% of the eligible U.S. population, as availability, reimbursement, and engagement present challenges to long-term success," the editorialists wrote. "The USPSTF recommendations to act early and identify and prevent diabetes may have their greatest value if they can reach young and vulnerable adults through a more diverse range of effective options for prevention."

- medpagetoday