By Dennis Thompson
HealthDay reporter
TUESDAY, Aug. 24, 2021 (HealthDay News) – The recommended age to start screening overweight and obese people for diabetes will be reduced by five years, from 40 to 35, the country’s leading panel of health experts announced.
The U.S. Task Force on Preventive Services (USPSTF) decided that earlier five-year testing could help detect more people with prediabetes, said Dr. Michael Barry, USPSTF Vice Chairman.
That would give these people a chance to avoid full blown diabetes by eating healthier diets, exercising more, and losing weight, said Barry, director of the informed medical decision making program at Massachusetts General Hospital in Boston.
Diabetes is “a major risk factor for heart attacks and strokes, but also the leading cause of blindness and kidney failure in the United States and a major cause of limb amputation,” he said. “Nobody would say that is not important.”
About 13% of American adults – 34 million people – have diabetes, according to the US Centers for Disease Control and Prevention.
But more than one in three (35%) have prediabetes, a condition in which blood sugar levels are higher than normal but have not yet irreversibly affected the body’s ability to respond to insulin.
“We know that epidemiologically we see an increase in the prevalence of both diabetes and prediabetes around the age of 35,” said Barry.
The new recommendation and the science behind it were published in the Journal of the American Medical Association on Aug. 24.
The recommendation of the USPSTF is important because under the Affordable Care Act (“Obamacare”) insurers are required to fully cover all screenings advocated by the task force without incurring patient costs.
In the case of diabetes, the screening includes a safe and simple blood test to check for either fasting blood sugar or hemoglobin A1C, Barry said.
The American Diabetes Association welcomed the updated screening recommendations.
“New cases of diabetes continue to rise, and we know that about a quarter of people with diabetes go undiagnosed,” said Dr. Robert Gabbay, the Association’s Scientific and Medical Director. “Lowering the age limit to 35 for people who are overweight or obese is a step in the right direction.”
The endocrinologist Dr. Emily Gallagher noted that in the guidelines, doctors should also consider screening diabetes for people in risk groups at an even earlier age. This includes people who:
- Belong to certain ethnic groups more susceptible to diabetes, including Native American / Alaskan, Asian, Black, Hispanic, and Pacific Islanders.
- Have a family history of diabetes.
- Had gestational diabetes during pregnancy.
- Have a history of ovarian cysts.
“It is important to note these reservations about the recommendations, especially when treating various populations who are at higher risk for diabetes in people of normal weight,” said Gallagher of Mount Sinai Hospital in New York City.
Some doctors believe the screening age could be even lower, given America’s ongoing obesity crisis.
“Personally, I think it would probably have been more beneficial to lower them further, especially since the rate of obesity and the incidence of type 2 diabetes in the younger population have also skyrocketed,” said Cleveland Clinic endocrinologist Dr. Mary Vouyiouklis Kellis.
Kellis pointed to another study published Aug. 24 in the Journal of the American Medical Association that found that the rate of type 2 diabetes in teens under the age of 19 nearly doubled between 2001 and 2017. The largest increases were in black teens and Hispanic teens.
But while the number of young people with diabetes is increasing, it remains relatively low. Study results show that in 2017, fewer than 1 in 1,000 American children had type 2 diabetes.
Barry said, “While obesity is certainly increasing in younger people, the rise in prediabetes and diabetes does not begin to rise until the age of 35. We have not been able to find any evidence that would allow us to lower the age of screening any further.”
More information
The U.S. Centers for Disease Control and Prevention has more about prediabetes, and you can view all of the U.S. Preventive Services Task Force’s screening recommendations here.
SOURCES: Michael Barry, MD, Director, Informed Medical Decision Making Program, Massachusetts General Hospital, Boston; Robert Gabbay, MD, PhD, senior researcher and medical officer, American Diabetes Association, Arlington, Virginia; Emily Gallagher, MD, PhD, endocrinologist, Mount Sinai Hospital, New York City; Mary Vouyiouklis Kellis, MD, endocrinologist, Cleveland Clinic, Ohio; Journal of the American Medical Association, August 24, 2021
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