Unseen woman pricking their finger to test their blood sugar level
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Focus on age, not weight, to capture the greatest number of people in all racial and ethnic groups with prediabetes and diabetes, reports a new Northwestern Medicine study. Making screening decisions based on age alone is also simpler for clinicians to implement, which may result in greater uptake of such testing.

The Northwestern investigators examined the clinical performance of the 2021 U.S. Preventive Services Task Force (USPSTF) prediabetes and diabetes screening recommendation, as well as alternate age and Body Mass Index (BMI) cutoffs. The USPSTF currently recommends screening only individuals 35 to 70 who are overweight or obese.

They looked at  data from 3,243 non-pregnant adults without diabetes. The data were examined overall, and by race and ethnicity.

This team found that screening all adults aged 35 to 70 years, regardless of weight, identifies the greatest proportion of adults with prediabetes and diabetes in the U.S. This approach, they say, will also maximize the ability to diagnose prediabetes and diabetes across all racial and ethnic groups.

“All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans,” said lead investigator Matthew O’Brien, an associate professor of medicine at Northwestern University Feinberg School of Medicine.

The study was published today in American Journal of Preventive Medicine.

“It might sound counterintuitive because we think of being overweight or obese as the primary cause of diabetes,” O’Brien said.

“But if we make decisions about diabetes testing based on weight, we will miss some people from racial and ethnic minority groups who are developing prediabetes and diabetes at lower weights,” he added.

Diagnosing diabetes in adults from racial and ethnic minority groups is often delayed when compared with white adults, the researchers said. A delayed diagnosis means the disease is harder to control, and individuals are more likely to develop diabetes complications in the heart, eyes and kidneys, while also having a higher risk of dying.

Approximately half of U.S. adults have Type 2 diabetes or prediabetes. Overall, 81% of adults with prediabetes are not aware of having the condition, and 23% of diabetes cases remain undiagnosed. Up to 70% of adults with prediabetes will eventually develop diabetes.

Asian Americans most often missed

Because Asian American adults often develop diabetes and prediabetes at a normal weight, they are the most likely racial group to be missed in the 2021 guidelines for prediabetes and diabetes screening, reports the new study. An estimated 6 million Asian Americans they say, have prediabetes or undiagnosed diabetes.

“It’s imperative that we identify a screening approach that is equitable across the entire U.S. population,” O’Brien said. “Our findings illustrate that screening all adults aged 35 to 70 years, regardless of weight or body mass index, performs equitably across all racial and ethnic groups.”

Studies, these authors say, have found that only half of eligible adults, or fewer, are tested for prediabetes and diabetes.

“There are many ways to nudge patients and providers to complete this testing, which should be the focus of future research,” O’brien said.

This epidemiologic study was conducted in collaboration with researchers from the U.S. Centers for Disease Control and Prevention (CDC) and Emory University using nationally representative data from the National Health and Nutrition Examination Surveys.

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