Adults between 40 and 70 years old who are overweight or obese should be screened for abnormal blood glucose as part of a cardiovascular risk assessment, according to a recommendation from the U.S. Preventive Services Task Force (USPSTF).
If people have abnormal blood glucose, the USPSTF recommends clinicians offer or refer them to intensive behavioral counseling and promote a healthy diet and physical activity.
The recommendation was published online in the Annals of Internal Medicine on Oct. 26.
Although the researchers found there was inadequate evidence that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity, they wrote that “the USPSTF concludes with moderate certainty that there is a moderate net benefit to measuring blood glucose to detect [impaired fasting glucose], [impaired glucose tolerance], or diabetes and implementing intensive lifestyle interventions for persons found to have abnormal blood glucose.”
Lead author Albert L. Siu, MD, MSPH, and his colleagues from the USPSTF noted that nearly a quarter of deaths caused by cardiovascular disease are preventable and that abnormal blood glucose is a modifiable risk factor.
They also mentioned that data from 2012 showed that approximately 86 million people in the U.S. who are 20 years old or older have impaired fasting glucose or impaired glucose tolerance. Of these people, an estimated 15 percent to 30 percent will develop type 2 diabetes within five years if they did not improve their health.
Risk factors for abnormal glucose metabolism include people who are overweight or obese, have a high percentage of abdominal fat, are physically inactive or smoke. The researchers said that abnormal glucose metabolism is frequently associated with hyperlipidemia, hypertension and other cardiovascular risk factors.
To detect glucose abnormalities, they recommend measuring hemoglobin A1c or fasting plasma glucose or using an oral glucose tolerance test. They added that a diagnosis of impaired fasting glucose. impaired glucose tolerance or type 2 diabetes should be confirmed by using the same test on a different day.
Although data on screening intervals is limited, the researchers mentioned that studies suggest screening every three years could be reasonable.
A healthy diet and exercise are the best ways to improve abnormal blood glucose, according to the researchers, who added that medications have not been proven to be as effective as behavioral interventions.
The American Medical Association said in a statement that it was “disappointed” by the USPSTF’s recommendations and noted that they were “significantly different” than draft recommendations released in the fall of 2014.
“While the AMA was supportive of the Task Force’s draft recommendations put forth one year ago that called for screening all individuals at high risk for diabetes, the final recommendations fall far short of meeting the needs of the American people who are suffering an epidemic of undiagnosed prediabetes and diabetes,” AMA president Steven J. Sack, MD, said in a statement. “The final recommendations reduce the target population of those who should be screened for diabetes—placing significantly less emphasis on the young as well as minority populations who are at high risk for undiagnosed diabetes. The AMA believes that this will only create a greater barrier to reaching the 86 million American adults currently living with prediabetes who are at high risk of developing diabetes.”
However, Sack said that the AMA was “very encouraged” with the USPSTF’s acknowledgment that lifestyle interventions are valuable for people with prediabetes. He added that the AMA encourages physicians to screen at-risk people of all ages, identify those with prediabetes and refer them to the National Diabetes Prevention Program, an evidence-based lifestyle change program led by the Centers for Disease Control and Prevention.