The following are key points to remember about this recommendation statement from the US Preventive Services Task Force (USPSTF) on screening for prediabetes and type 2 diabetes:

1. To update its 2015 recommendation, the USPSTF commissioned a systematic review to evaluate screening for prediabetes and type 2 diabetes in asymptomatic, nonpregnant adults.
2. Approximately 13% of all US adults have diabetes, and 34.5% meet criteria for prediabetes. Among adults with diabetes, 21.4% were not aware or did not report having diabetes, per data from the Centers for Disease Control and Prevention (CDC). Only 15.3% of adults with prediabetes report being told of their condition by a health provider. The prevalence of prediabetes and diabetes increases with age.
3. Diabetes is estimated to be the seventh leading cause of death in the US and the leading cause of renal failure and new cases of blindness. In addition, an increased risk for cardiovascular disease (CVD) and nonalcoholic fatty liver is also associated with diabetes.
4. The updated recommendation now recommends a lower age for screening (from 40 to 35 years old). In addition, the USPSTF now recommends screening for prediabetes and diabetes among adults ages 35-70 years who are overweight or obese who are not pregnant.
5. The USPSTF also recommends that providers consider screening at an earlier age if the patient is from a population with a disproportionately high prevalence of diabetes (American Indian/Alaska Native, Black, Hawaiian/Pacific Islander, Hispanic/Latino), and at a lower body mass index (≥23 kg/m²) if the patient is Asian American.
6. The frequency of screening is uncertain among adults with an initial normal glucose level. However, screening every 3 years is reasonable. Measurement of glycated hemoglobin (HbA1c) or oral glucose tolerance testing is recommended for screening. A fasting plasma glucose level of 126 mg/dl (6.99 mmol/L) or greater, an HbA1c level of 6.5% or greater, or a 2-hour post-load glucose level of 200 mg/dl (11.1 mmol/L) or greater are consistent with the diagnosis of type 2 diabetes. A fasting plasma glucose level of 100-125 mg/dl (5.55-6.94 mmol/L), an HbA1c level of 5.7%-6.4%, or a 2-hour post-load glucose level of 140-199 mg/dl (7.77-11.04 mmol/L) are consistent with prediabetes.
7. The USPSTF found adequate evidence that interventions for newly diagnosed diabetes have a moderate benefit in reducing all-cause mortality, diabetes-related mortality, and risk of myocardial infarction after 10-20 years of intervention.
8. The USPSTF found convincing evidence that preventive interventions, particularly lifestyle interventions, in persons identified as having prediabetes have a moderate benefit in reducing the progression to type 2 diabetes and reducing other CVD risk factors such as blood pressure and lipid levels.
9. The USPSTF found inadequate direct evidence that screening for type 2 diabetes or prediabetes leads to mortality or CV morbidity improvements.
10. In summary, the USPSTF concludes with moderate certainty that screening for prediabetes and type 2 diabetes and offering or referring patients with prediabetes to effective preventive interventions has a moderate net benefit. This includes behavioral weight loss interventions for adults with obesity.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Blood Glucose, Blood Pressure, Body Mass Index, Diabetes Mellitus, Type 2, Diagnostic Tests, Routine, Fasting, Glucose Tolerance Test, Hemoglobin A, Life Style, Lipids, Myocardial Infarction, Obesity, Overweight, Prediabetic State, Pregnancy, Primary Prevention, Renal Insufficiency, Risk Factors, Weight Loss

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