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Earlier Diabetes Screening in People who are Overweight

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The U.S. Preventive Services Task Force has updated its recommendation on diabetes screening for people with a body mass index (BMI) of 25 or greater. The BMI is a measure of body fat based on weight and height. The new recommendation suggests that such individuals should be screened for prediabetes and diabetes every three years starting at age 35, rather than age 40. This is because early screening can help detect cases of prediabetes and diabetes sooner, and prevent some of the worst effects of the disease. The global prevalence of impaired glucose tolerance among adults was 6.4% in 2011, and is projected to increase to 7.1% by 2030. Almost 30% of adult Americans have prediabetes, and over 40% have hyperglycemia of any kind, i.e. prediabetes or diabetes. Close to 40% of US adults with diabetes have cardiovascular disease. Diabetes accounts for up to 40% of cases of end-stage renal disease in the US. Approximately 25% of Americans with diabetes report visual impairment. 

Screen detected diabetes refers to the diagnosis of diabetes through routine screening tests, rather than as a result of symptoms or complications. In other words, it is the identification of diabetes in an individual who does not have any obvious signs or symptoms of the condition. Several studies have shown that up to 50% of people with newly diagnosed or screen-detected diabetes already exhibit diabetes-related macrovascular (e.g., ischemic heart disease or myocardial infarction) and microvascular complications (e.g., retinopathy, chronic kidney disease and neuropathy).

Screening for diabetes is typically recommended for individuals who are at high risk of developing the condition, such as those who are overweight or obese, have a family history of diabetes, or have high blood pressure. The purpose of screening is to identify diabetes in its early stages, before it causes any damage to organs like the heart, kidneys, or eyes.

If multiple risk factors are present, screening should be done at an earlier age and more frequently. Impaired fasting glucose (IFG) is a condition in which blood sugar levels are higher than normal, but not high enough to be classified as diabetes. IFG is diagnosed when fasting blood sugar levels are between 100 and 125 mg/dL. This condition is also known as prediabetes, as individuals with IFG are at a higher risk of developing diabetes in the future. IFG can be caused by a variety of factors, including obesity, physical inactivity, and a diet high in refined carbohydrates. Like diabetes, IFG can increase the risk of developing complications such as heart disease, stroke, and kidney damage. Lifestyle changes such as weight loss and increased physical activity can help prevent or delay the onset of diabetes in individuals with IFG.

This Difference Between Impaired Glucose Tolerance and Impaired Fasting Glucose

Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are both conditions that fall under the umbrella of prediabetes. However, they are diagnosed based on different criteria.

IFG is diagnosed when fasting blood sugar levels are between 100 and 125 mg/dL, while IGT is diagnosed when blood sugar levels are between 140 and 199 mg/dL two hours after consuming a sugary drink.

In other words, IFG is a measure of blood sugar levels after an overnight fast, while IGT is a measure of blood sugar levels after consuming a sugary drink. Both conditions indicate that blood sugar levels are higher than normal, but not high enough to be classified as diabetes.

The risk factors for IFG and IGT are similar, including obesity, physical inactivity, and a diet high in refined carbohydrates. Lifestyle changes such as weight loss, increased physical activity, and a healthy diet can help prevent or delay the onset of diabetes in individuals with either IFG or IGT.

It's worth noting that some individuals may have both IFG and IGT, as they are not mutually exclusive conditions.

The CDC reports that many people with diabetes, approximately 21.4%, are unaware that they have the condition. Diabetes was the seventh leading cause of death in the United States in 2017. If left uncontrolled, it can lead to serious health effects, such as kidney failure, blindness, and cardiovascular and liver disease. The US Preventive Services Task Force (USPSTF) recommends screening for undiagnosed type 2 diabetes in adults with a sustained blood pressure ≥135/80 mmHg. 

Screening for diabetes typically involves measuring blood sugar after an eight-hour fast or getting a blood test for hemoglobin A1C. If you are at high risk of developing diabetes, your doctor may recommend starting screening at an even younger age. The psychological effects of receiving a diagnosis of prediabetes largely remain unclear. However, there are suggestions that participation in a diabetes prevention program would not be associated with higher levels of anxiety, depression or overall psychological distress.

As rates of obesity continue to climb around the world, so does the prevalence of diabetes. In the United States alone, over 34 million people have diabetes, and an additional 88 million have prediabetes. Diabetes is a chronic condition that affects the way the body processes blood sugar, and it can lead to serious complications like heart disease, stroke, blindness, and kidney failure.

One of the biggest risk factors for developing diabetes is being overweight or obese. According to the American Diabetes Association, 84% of adults with type 2 diabetes are overweight or obese. This is why new recommendations have been made for earlier diabetes screening in people who are overweight.

The Importance of Early Detection

Early detection of diabetes is critical because it can help prevent or delay the onset of serious complications. When diabetes is caught early, lifestyle changes and medications can be used to manage blood sugar levels and prevent damage to organs like the heart, kidneys, and eyes.

In addition to preventing complications, early detection can also improve the quality of life for people with diabetes. By managing blood sugar levels, individuals can reduce their risk of fatigue, nerve damage, and other symptoms associated with diabetes.

The New Recommendations

The American Diabetes Association and the American College of Physicians recently issued new recommendations for earlier diabetes screening in people who are overweight. The guidelines suggest that individuals with a body mass index (BMI) of 25 or higher, who are between the ages of 35 and 70, should be screened for diabetes every three years.

This is a change from previous guidelines, which recommended screening for diabetes only in individuals with a BMI of 25 or higher who had additional risk factors, like a family history of diabetes or high blood pressure.

The new recommendations are based on the growing evidence that early detection and treatment of diabetes can improve health outcomes and prevent complications. The guidelines also reflect the fact that obesity is a major risk factor for diabetes and that overweight individuals should be screened more frequently to catch diabetes early.

How Diabetes Screening Works

Diabetes screening typically involves a blood test that measures blood sugar levels. There are several types of blood tests that can be used to screen for diabetes, including the A1C test, the fasting plasma glucose test, and the oral glucose tolerance test.

The A1C test measures average blood sugar levels over the past two to three months, while the fasting plasma glucose test measures blood sugar levels after an overnight fast. The oral glucose tolerance test measures blood sugar levels before and after drinking a sugary drink.

If the results of a diabetes screening test are abnormal, further testing may be needed to confirm a diagnosis of diabetes.

Conclusion

Overweight and obesity are major risk factors for developing diabetes. That's why it's important for individuals who are overweight to be screened for diabetes earlier than previously recommended. Early detection and treatment of diabetes can help prevent or delay complications and improve the quality of life for people with diabetes. If you're overweight and between the ages of 35 and 70, talk to your healthcare provider about getting screened for diabetes. It could save your life.

If you are diagnosed with prediabetes, lifestyle changes such as improving your diet, exercising, and losing weight, along with certain medications, may prevent or delay the development of diabetes.

Caroline Buckee

Caroline Flannigan is an epidemiologist. She is an Associate Professor of Epidemiology and is the Associate Director of the Center for Communicable Disease Dynamics.

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