Screening for Diabetes: Why Age Matters More Than Weight
[Mar. 24, 2023: JJ Shavit, The Brighter Side of News]
Scientists at the University of Geneva (UNIGE) have been working for several years on an alternative therapy based on the S100A9 protein. (CREDIT: iStock Photo)
Northwestern Medicine researchers have found that screening all adults aged 35 to 70 years, regardless of weight, is the best way to diagnose prediabetes and diabetes in the US, particularly for racial and ethnic minorities. This approach is most effective in identifying people with prediabetes and diabetes in all racial and ethnic groups, according to the study in the American Journal of Preventive Medicine.
Dr. Matthew O’Brien, lead investigator of the study and an associate professor of medicine at Northwestern University Feinberg School of Medicine, explained that the idea of focusing on weight alone when screening for diabetes may not capture a significant number of people from different racial and ethnic groups who develop the condition at lower weights than white adults. "All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans," said O'Brien.
Diagnosing diabetes in adults from racial and ethnic minority groups is often delayed when compared with white adults. A delayed diagnosis means the disease is harder to control, and individuals are more likely to develop diabetes complications in the heart, eyes and kidneys, while also having a higher risk of dying.
“Diabetes is a condition in which unacceptable racial and ethnic disparities persist,” O’Brien said. “That’s why we need a screening approach that maximizes equity. If we can find everyone earlier, it helps us reduce these disparities and the bad outcomes that follow.”
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The study highlights that current guidelines set by the US Preventive Services Task Force (USPSTF) only recommend screening individuals aged 35 to 70 who are overweight or obese. However, the study’s findings indicate that the approach should be more inclusive, and that screening based on age alone, regardless of weight, is a more effective approach.
Asian Americans are particularly at risk of being missed in the current screening guidelines for prediabetes and diabetes because they tend to develop the condition at a normal weight. An estimated 6 million Asian Americans have prediabetes or undiagnosed diabetes, according to the new study. This underscores the importance of having a screening approach that is equitable across all racial and ethnic groups.
The researchers evaluated several options for earlier screening and provided evidence that can inform future changes to the Task Force's guideline. They believe that making screening decisions based on age alone is simpler for clinicians to implement and may result in greater uptake of this screening approach.
BMI cutoff ranges. (CREDIT: CDC)
“There are many ways to nudge patients and providers to complete this testing, which should be the focus of future research,” said O’Brien.
The study was conducted in collaboration with researchers from the US Centers for Disease Control and Prevention and Emory University using nationally representative data from the National Health and Nutrition Examination Surveys. Other Northwestern authors include Stacy Bailey, Dr. Sadiya Khan, and Dr. Ronald Ackermann.
Diabetes vs Prediabetes ranges for major blood test values. (CREDIT: CDC)
According to the researchers, approximately half of US adults have Type 2 diabetes or prediabetes, representing a major public health concern. Moreover, 81% of adults with prediabetes are not aware of having the condition, and 23% of diabetes cases remain undiagnosed. Up to 70% of adults with prediabetes will eventually develop diabetes.
· All racial/ethnic minority groups develop diabetes at lower weights than white adults
· Screening all adults aged 35 to 70 years identifies the greatest proportion of adults with prediabetes and diabetes
· A ‘huge portion’ of the U.S. population has undiagnosed prediabetes or diabetes
The study's authors hope that their findings will inform policymakers and healthcare providers to implement more equitable screening methods for prediabetes and diabetes in the US.
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