Screening Recommendations for Type 2 Diabetes Mellitus

Screening is recommended for type 2 diabetes because reliable tests are available, and lifestyle changes and medications reduce progression and adverse sequelae of the disease, even in persons who are initially asymptomatic.

 

Summary of Screening Recommendations for Type 2 Diabetes Mellitus

American Association of Clinical Endocrinologists

Screen asymptomatic individuals if risk factors present:

  1. Acanthosis nigricans
  2. Age ≥ 45 years
  3. Antipsychotic therapy for schizophrenia and/or severe bipolar disease
  4. Cardiovascular disease or family history of type 2 diabetes
  5. Chronic glucocorticoid exposure
  6. HDL cholesterol level < 35 mg per dL (0.91 mmol per L) and/or a triglyceride level > 250 mg per dL (2.8 mmol per L)
  7. History of gestational diabetes mellitus or delivery of a baby weighing > 9 lb (4.1 kg)
  8. Hypertension (blood pressure > 140/90 mm Hg or taking medication for hypertension)
  9. Impaired glucose tolerance, impaired fasting glucose, and/or metabolic syndrome
  10. Member of an at-risk racial or ethnic group: Asian, black, Hispanic, Native American (Alaska Native or American Indian), or Pacific Islander
  11. Nonalcoholic fatty liver disease
  12. Overweight or obese
  13. Polycystic ovary syndrome
  14. Sedentary lifestyle
  15. Sleep disorders in the presence of glucose intolerance (A1C > 5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing), including obstructive sleep apnea, chronic sleep deprivation, and night-shift occupation, every three years
  16. Screen persons with two or more risk factors annually

American Diabetes Association

Screen asymptomatic adults with a body mass index ≥ 25 kg per m2, and one or more additional risk factors:

  1. A1C > 5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing
  2. Acanthosis nigricans
  3. Cardiovascular disease
  4. First-degree relative with type 2 diabetes
  5. HDL cholesterol level < 35 mg per dL and/or a triglyceride level > 250 mg per dL
  6. High-risk ethnicity: black, Native American/Alaska Native, Hispanic/Latino, Asian American, and Native Hawaiian/Pacific Islander
  7. Hypertension (blood pressure > 140/90 mm Hg or taking medication for hypertension)
  8. Physical inactivity
  9. Polycystic ovary syndrome
  10. Women who had gestational diabetes or who delivered a baby weighing > 9 lb

In persons without risk factors, testing should begin at 45 years of age

If test results are normal, repeat testing should be performed at least every three years

Canadian Task Force on Preventive Health Care

Screening is not recommended for adults at low to moderate risk of diabetes (risk determined with a validated risk calculator: FINDRISC and CANRISK, which factor in age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables)

For adults at high risk of diabetes, routine screening every three to five years with A1C

For adults at very high risk of diabetes, routine screening annually with A1C

U.S. Preventive Services Task Force

Screen all adults 40 to 70 years of age who are overweight or obese.

Consider screening earlier in patients with higher risk (i.e., one of the following): family history of diabetes; members of certain racial and ethnic groups (i.e., blacks, American Indians or Alaska Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders); personal history of gestational diabetes or polycystic ovary syndrome

CANRISK = Canadian Diabetes Risk Assessment Questionnaire; FINDRISC = Finnish Diabetes Risk Score Questionnaire; HDL = high-density lipoprotein.

 

 

References:

  1. Pippitt K, Li M, Gurgle HE. Diabetes Mellitus: Screening and Diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-9. [Medline]
  2. Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015 Jun 2;162(11):765-76. [Medline]

 

Created Aug 31, 2018

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