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New Diabetes Screening Recommendation Misses More Than Half of High-Risk Patients

Study evaluates USPSTF guidelines in clinical practice

The latest government guidelines that physicians follow to determine whether patients should be screened for diabetes missed 55% of high-risk individuals with prediabetes or diabetes, a Northwestern Medicine study has found.

The 2015 screening guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend that patients be screened for diabetes if they are between 40 and 70 years of age and are overweight or obese. But the new study found that many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities. 

Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications, the investigators say.

The study, published online in PLOS Medicine, is the first to examine how the USPSTF guidelines, issued in October 2015, may perform in practice.

Under a provision in the Patient Protection and Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out-of-pocket.

“Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly,” said senior author Dr. Matthew O’Brien. “If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes.” 

The researchers looked at electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.

Fifty-four percent of white patients who developed dysglycemia fell within the screening guidelines, compared with 50% of African-American patients and 37% of Latino patients, according to the study.

O’Brien said the USPSTF is on the right track with its guidelines because they focus on the two risk factors––age and weight––that are most predictive of developing dysglycemia. However, physicians should be aware of the new study’s findings so they can understand who may be missed by the USPSTF’s criteria and decide whether to screen those patients, he said.

“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,” O’Brien said.

With the new findings, O’Brien said the next steps are to decide what other factors should be taken into account when determining who is at risk for diabetes and to use electronic health records to automatically prompt providers to screen patients who have those risk factors.

Source: Northwestern University; July 12, 2016.

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