COMMENTARY

Are the Diabetes Screening Criteria Outdated?

Gregory A. Nichols, PhD

Disclosures

September 27, 2013

Utility of the US Preventive Services Task Force Criteria for Diabetes Screening

Casagrande SS, Cowie CC, Fradkin JE
Am J Prev Med. 2013;45:167-174

Study Summary

The US Preventive Services Task Force (USPSTF) recommends screening for type 2 diabetes only among adults with blood pressure (BP) > 135/80 mm Hg. The purpose of this study was to determine the effectiveness of those screening criteria for identifying adults with undiagnosed diabetes.

Using the National Health and Nutrition Examination Survey (NHANES), the investigators studied adults older than 20 years of age who completed the interview and visited a mobile examination center during the 2003-2010 NHANES cycles. People with a fasting plasma glucose (FPG) level ≥ 126 mg/dL or A1c level ≥ 6.5% who did not self-report a diagnosis of diabetes were determined to have undiagnosed diabetes. Sensitivity, false-negative values, specificity, and false-positive values were calculated using BP > 135/80 mm Hg as the screening cut-off point for identifying undiagnosed diabetes. Among people with undiagnosed diabetes, the prevalence of elevated risk factors for cardiovascular disease was assessed using USPSTF diabetes screening criteria.

Among all people older than 20 years without diagnosed diabetes, 4% had undiagnosed diabetes by FPG or A1c criteria, 2.2% had undiagnosed diabetes and BP ≤ 135/80 mm Hg, and 1.8% had BP > 135/80 mm Hg. This BP cut-off resulted in the detection of only 44.4% of persons with undiagnosed diabetes. Nearly 75% of people without undiagnosed diabetes were correctly determined, but 25% were identified for screening even though they did not have undiagnosed diabetes. The prevalence of risk factors for cardiovascular disease (A1c level, low-density lipoprotein and high- density lipoprotein cholesterol, body mass index ≥ 30 kg/m2, current smoking, and current medication use for hypertension and hyperlipidemia) among people with undiagnosed diabetes was not significantly different using the BP screening cut-point.

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