COMMENTARY

Are the Diabetes Screening Criteria Outdated?

Gregory A. Nichols, PhD

Disclosures

September 27, 2013

Viewpoint

Most guidelines, such as those from the American Diabetes Association,[1] recommend diabetes screening in the presence of various risk factors, such as age, obesity, and family history. In clinical practice, targeted screening that is broader than the USPSTF guideline is probably occurring. So why does it matter that the present study shows that the USPSTF guideline does not perform well?

From a practical standpoint, it matters because the USPSTF guidelines figure into what is and is not covered free of charge by health insurance plans. This means that a health plan could choose to not cover diabetes screening if a patient's BP is not elevated. Because the USPSTF issued its guidelines in 2008, there is considerable accumulated evidence of the benefits of early diagnosis and treatment of diabetes, including the "legacy effect" of early glycemic control and better response and durability of metformin therapy.[2,3,4] Thus, at the very least, the USPSTF guidelines should be updated.

The goal of screening is to identify people who have a disease or are at risk for developing it, so that we can work on prevention and treatment of risk factors. In the case of diabetes, prevention and treatment is as much about its complications (especially cardiovascular disease) as it is about diabetes itself. There is little doubt that many patients can benefit from these efforts regardless of their current blood pressure. Indeed, diabetes prevention is cost-effective and perhaps even cost-saving.[5]

Abstract

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