An Additional 12 Million US Adults Become Eligible for Diabetes Screening
New USPSTF and ADA guidelines recommend testing for prediabetes and type 2 diabetes at age 35.
About 38 million Americans have diabetes, and 1 in 5 don’t know they have it. Given the continued increase in the number of people with diabetes, experts have updated the US Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines for who should get tested for prediabetes and type 2 diabetes.
This study examined how many people would become eligible for testing under the new guidelines and whether these guidelines can address barriers to diabetes screening.
Glucose Testing Guidelines
Glucose testing is a blood test to measure a person’s glucose (blood sugar) levels. Health care providers use the test to find out if someone has prediabetes, or type 1, type 2, or gestational diabetes.
This study looked at USPSTF and ADA guidelines, which are the most commonly used recommendations for glucose testing. Both guidelines have expanded criteria of who to test to identify prediabetes and type 2 diabetes:
- Previously, USPSTF recommended glucose testing for people aged 40 to 70 with overweight or obesity. In 2021, USPSTF expanded the criteria to people aged 35 to 70 with overweight or obesity.
- Previously, ADA recommended all adults 45 years or older regardless of weight and risk be screened for prediabetes and type 2 diabetes. In 2022, ADA lowered the screening age to 35 years. Additionally, ADA recommends that adults at any age with overweight or obesity and with at least one risk factor for type 2 diabetes receive glucose testing.
- In addition to the age criteria, both guidelines also consider other risk factors such as a family history of diabetes and physical inactivity.
What Did This Study Examine?
Researchers studied over 6,000 non-pregnant US adults without diagnosed diabetes to estimate the percentage who reported having their glucose tested. They also examined whether screening practices aligned with guidelines and which population groups were less likely to receive testing. These nationally representative data offer insights into current diabetes screening practices.
What Were the Results?
This study found that:
- With the new guidelines, an additional 12 to 14 million US adults are now eligible for glucose testing.
- Just over half (52%) of all US adults reported having a glucose test in the past 3 years. However, nearly 25% were not eligible for the test yet based on the new USPSTF guideline, and 5% were not eligible based on the new ADA guideline.
- Younger adults (18–44 years), men, Hispanic adults, people who did not graduate from high school, people living in poverty, and people without health insurance or a usual health care provider were less likely to receive glucose testing.
What Are the Take-home Messages?
- Current glucose testing practices do not align with guidelines. Some people who were not eligible as a result of their age or risk factors reported receiving the test.
- The updated guidelines do not directly address the social determinants of health, which present barriers to receiving glucose testing. Adults with lower income or educational levels are more likely to have diabetes but less likely to receive glucose testing. Broad system or programmatic efforts may be needed to close the testing gaps in this population.
- New USPSTF guideline recommends adults with overweight or obesity be screened for prediabetes and type 2 diabetes every 3 years starting at age 35. New ADA guideline recommends all adults be screened at least once every 3 years starting at age 35 if results are normal. Using the same age can reduce confusion for health care providers in ordering and explaining test results to their patients.
- More than 20% of Americans with diabetes don’t know they have it, and more than 80% of Americans with prediabetes are not aware of their risk for type 2 diabetes. To address these gaps in awareness, it’s important for health care providers to engage with their patients and talk with them about diabetes and related risks.