screening for diabetes mellitus

Introduction

Recommendations differ depending upon organization.

Indications

USPSTF

• overweight adults age 35-70 years (BMI >= 25) as part of cardiovascular risk assessment
• asymptomatic adults with sustained blood pressure > 130/80 mm Hg.

Endocrine Society

• all pregnant women at 1st prenatal visit

American Diabetes Association

• all persons every 3 years beginning at age 45 years
• screening cost-effective when begun age 30-45 years & repeated every 3-5 years
• consider screening patients < 45 years if BMI >= 25 +
  • additional risk factors
    • 1st degree relative with diabetes mellitus type 2
    • ethnic risk: Hispanic, American Indian, African American, Asian American, Pacific Islander
    • inactivity
    • severe obesity
    • history of gestational diabetes
    • delivery of large infant > 9 lbs (4.1 kg)
    • dyslipidemia
      • low HDL cholesterol (< 35 mg/dL)
      • high serum triglycerides (> 250 mg/dL)
    • hypertension (BP > 140/90 mm Hg)
    • polycystic ovary syndrome
    • acanthosis nigricans
    • impaired fasting glucose
    • history of impaired glucose tolerance test
    • hemoglobin A1c >= 5.7%
    • history of cardiovascular disease
    • use of glucocorticoids or antipsychotics

US Preventive Services Task Force

• age >= 35-45 years
• adults at high risk for type 2 diabetes, defined as:
  • overweight or obese (35 years)
  • first-degree relative with diabetes
  • history of gestational diabetes
  • history of polycystic ovary syndrome
  • high risk ethnicity (black, Native American, Latino. native Hawaiian or Pacific islander, Asian American)
  • screening every 3 years

American Diabetes Association

• screen Asian-Americans with BMI >= 23

Any adult with cardiovascular disease, hypertension or dyslipidemia

Diagnostic criteria

• 8 hr fasting plasma glucose > 126 mg/dL on 2 separate occasions
• HgbA1c of >= 6.5%
• plasma glucose > 200 mg/dL 2 hr after 75 ng oral glucose tolerance test
• random plasma glucose > 200 mg/dL with symptoms of hyperglycemia
• 2 separate screening tests done simultaneously & both are abnormal

Benefit/risk

• no mortality benefit within 10 years of screening for diabetes mellitus type 2
• treatment of impaired fasting glucose or impaired glucose tolerance with lifestyle intervention associated with decreased mortality after 23 years

Laboratory

• fasting plasma glucose (< 110 mg/dL is normal*)
• hemoglobin A1c
• oral glucose tolerance test (< 140 mg/dL at 2h is normal)

* 100 mg/dL

Repeat testing every 3 years if normal.

Repeat every 1-2 years for patients with prediabetes.

Notes

• screening of all middle-age adults for type 2 diabetes does not lower 10 year mortality risk
• risk missing or overdiagnosing diabetes
• interventions such as lifestyle changes & metformin, with low adherence rates (<30%) & modest effects

More general terms

• screening for endocrine disease

Additional terms

• diabetes mellitus
• diabetes mellitus type 2 (insulin-resistant)
• prediabetes

Patient information

screening for diabetes mellitus patient information