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USPSTF Evidence Review Could Lead to Revised Screening Guidelines

Mary K. Caffrey
Recent emphasis of identifying those with prediabetes and intervening to halt its progression is aimed at reducing the financial impact of diabetes in the United States, which was estimated in 2012 at $245 billion.
A look at the most recent evidence on how to identify those at risk for diabetes could lead the US Preventive Services Task Force (USPSTF) to shift how the healthcare system screens for prediabetes.1 In October 2014, a draft guideline shifted the focus from those with elevated blood pressure (BP) to persons with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).2

A USPSTF literature review, published April 14, 2015, in the Annals for Internal Medicine,1  found that millions of Americans could avoid the progression to diabetes if screening for abnormal glucose became the routine for adults 45 years and older; screening would be recommended for younger adults with risk factors.3

The review did not find a 10-year mortality benefit from screening. However, screening for IFG or IGT did help delay the progression, which could have important implications for managed care. The costs associated with diabetes in the United States, estimated at $245 billion in 2012,4  come from both medical costs as patients gradually develop complications, including kidney failure or blindness, and from lost productivity, including disability costs that occur when some patients are unable to work.

Early identification of those with prediabetes, along with education and intervention, has received plenty of attention from both the medical and public health communities, notably through the launch of Diabetes STAT by the American Medical Association and CDC.5

The literature review synthesized 16 trials that consistently found the treatment of IFG or IGT was associated with a delayed progression to diabetes. Most trials of treatment for either condition found no effects on all-cause or cardiovascular mortality.

In 2008, the USPSTF issued a B recommendation for diabetes screening in asymptomatic adults with sustained BP greater than 135/80 mmHg. The recommendation was based on the ability of screening to identify those with diabetes, as well as evidence that treating BP was associated with reduced risk for cardiovascular events. At that time, the USPSTF did not find sufficient evidence to include screening for adults without elevated BP.1

References

1.      Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for type 2 diabetes mellitus: a systematic review for the US Preventive Services Task Force [published online April 14, 2015]. Ann Intern Med. doi:10.7326/M14-2221.

2.      Draft recommendation statement.  Abnormal glucose and T2DM in adults: screening. US Preventive Service Task Force website. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement43/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus. Published October 2014. Accessed April 14, 2015.

3.      Tucker ME. USPSTF evidence review supports prediabetes screening. Medscape website. http://www.medscape.com/viewarticle/843020. Accessed and published April 14, 2015.

4.      American Diabetes Association. Economic costs of diabetes in the United States. Diabetes Care. 2013;36:1033-1046.

5.      Caffrey MK. AMA, CDC launch Diabetes STAT to prevent more cases of type 2. Am J Manag Care. 2015;21(SP5):SP152.

 
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