Current screening criteria may miss 50% of diabetic, prediabetic patients

A study published April 12 in the Journal of General Internal Medicine found that screening patients for diabetes based only on age and weight could be miss more than half high-risk patients.

The recommendation from the U.S. Preventive Service Task Force (USPSTF) states physicians should screen patients for prediabetes or type 2 diabetes when they are between 40 and 70 years old and overweight or obese. In this study, researchers from Northwestern Medicine outlined how that recommendation could be limiting patients screened, especially in racial and ethnic minorities.

The study compared this conventional screening process to an expanded criteria recommendation that included factors like family history of diabetes, a history of gestational diabetes and non-white race or ethnicity. Some 3,643 participants without diagnosed diabetes were evaluated.

Results showed the conventional screening criteria meant 53 percent of patients who had prediabetes or type 2 diabetes were not screened due to the lack of inclusion of the criteria. Using the expanded set of criteria resulted in only 23 percent of patients with prediabetes or type 2 diabetes being missed.

"This seems like a no-brainer to screen patients who have any of these additional risk factors," said lead author Matthew O'Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine. "By demonstrating how well these expanded criteria work in identifying patients with prediabetes and diabetes, we're proposing a better path for the USPSTF to strengthen its screening guidelines."

The study also showed the ethnic disparities—with 50 percent of white patients with prediabetes or type 2 diabetes being identified while 48 percent of African-Americans and 44 percent of Latinos were identified. Asian populations were missed most often with only 30 percent with prediabetes or type 2 diabetes being identified using the conventional criteria.

"This could be a particular problem for people of low socioeconomic status who are at high risk of developing diabetes and may be unable to pay for a screening test," O'Brien said. "The earlier patients are diagnosed with these conditions, the sooner they can begin to combat them.”