Screen people with prediabetes according to age not weight, screen all above 35 years of age: USPTF

U.S. Preventive Services Task Force in 2021 recommended screening adults (asymptomatic) aged 35 – 70 years for prediabetes and diabetes screening with overweight/obesity. The age was lowered compared to its 2015 recommended age of 40 years. The racial and ethnic groups with high diabetes risk at younger ages or lower BMI were considered for early screening.

In a recent study, Nationally representative data was used to collect information of 3,243 nonpregnant adults without diagnosed diabetes (January 2017–March 2020). Age and BMI were the criteria used for screening eligibility.

Prediabetes and undiagnosed diabetes were defined by fasting plasma glucose ≥100 mg/dL or haemoglobin A1c ≥5.7%. The team examined sensitivity, specificity, and predictive values of alternate screening criteria by race and ethnicity.

The study results are:

• As per 2021 criteria, there was marginally higher sensitivity (58.6%vs vs. 52.9%) and lower specificity (69.3% vs 76.4%) compared to the 2015 criteria overall and within racial and ethnic group.
• Screening at lower age and BMI thresholds caused greater sensitivity and lower specificity among Hispanic, non-Hispanic Black, and Asian adults.
• Screening all adults aged 35–70 regardless of BMI gave equitable performance.

Concluding further, 2021 U.S. Preventive Services Task Force screening criteria identify more adults with prediabetes and diabetes with even higher sensitivity and performed by race and ethnicity compared to 2015 criteria.

Further reading:

Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity. https://doi.org/10.1016/j.amepre.2023.01.007