New Recommendations for Diabetes Screenings for Those Classified as Obese or Overweight
New insight from the U.S. Preventative Services Task Force (USPSTF) says overweight and obese adults should now be screened for diabetes starting at age 35.
Previously, the USPSTF suggested diabetes screenings starting at age 40.
The new recommendations are based on the BMI scale, which experts say might not be the best measurement of health.
Experts note that a person's BMI is just one of many risk factors for the development of diabetes.
Experts have long been aware of the link between weight, type 2 diabetes, and prediabetes. Now, a new recommendation published in JAMA from the U.S. Preventive Services Task Force (USPSTF), is doubling down on that connection, and changing its recommendations around when adults should begin diabetes screenings.
The USPSTF recently evaluated screenings for prediabetes and type 2 diabetes in overweight and obese adults ages 30 to 70 who are not pregnant and have no symptoms of diabetes, and found that it needed to update its 2015 recommendation.
What is diabetes, anyway?
While there are different types of diabetes, they all stem from the body’s inability to regulate blood sugar. Those with prediabetes or type 2 diabetes don’t make enough insulin or can’t use the insulin it makes as well as it should, leaving too much sugar (or rather, glucose) in the bloodstream. (Type 1 diabetes is an absolute deficiency of insulin, and is not affected by these recommendations.)
Prediabetes and type 2 diabetes are detected using a variety of tests doctors administer. Common tests include measuring fasting plasma glucose levels, HbA1c (a measure of long-term blood glucose concentration through a finger prick), or with an oral glucose tolerance test, according to the JAMA article. These tests should be administered by a doctor to those considered overweight or obese starting at age 35.
Despite being quite common in the U.S., (an estimated 13% of all U.S. adults 18 and older have a form of diabetes, and 34.5% meet criteria for prediabetes, according to JAMA), there is still no cure. But taking certain medications, making lifestyle changes (like diet and exercise) can help, according to the CDC—which is why early detection is key.
What is the USPSFT's new recommendation?
The new recommendation states that those who qualify based off of their Body Mass Index (BMI) begin diabetes screenings at age 35, instead of the previously recommended 40. The qualifiers for overweight or obese were defined by JAMA as those with a BMI above 25 and 30, respectively.
But the BMI scale is not always the best indicator of overall health, as it does not differentiate between muscle and fat or consider ethnic differences in body type, according to recent findings.
“The BMI scale can be a useful guide in general, but is inaccurate for skinny fat (thin-outside-fat-inside) populations and those that have large muscle mass,” explains Danine Frudge M.D., Medical Director at Pritikin Longevity Center. Prediabetes and type 2 diabetes are most closely related to abdominal fat specifically, and a larger body composition analysis (called a DEXA body composition analysis) can be a helpful indicator of your level of abdominal fat.
It's important to note that a person's BMI is just one of many risk factors for the development of diabetes, explains Jacqueline Lonier, M.D., adult endocrinologist at the Naomi Berrie Diabetes Center in New York City. Other risk factors for developing prediabetes or type 2 diabetes include family history, hypertension, high HDL cholesterol levels, and women with Polycystic Ovarian Syndrome (PCOS).
What does this recommendation really mean?
The new recommendations are focused on screenings for prediabetes and type 2 diabetes specifically. Since about 90-95% of people with diabetes tend to have type 2 diabetes, and about 88 million people in the U.S. (about one in three adults) have prediabetes (which raises your risk for type 2 diabetes, heart disease, and stroke, according to the CDC) the new recommendations affect a lot of the population.
Even though Dr. Frudge warns that BMI isn’t the best indicator of overall health, Dr. Lonier is on board with using it to help determine who should begin screening for diabetes at a younger age, as it could potentially help prevent serious illness.
“I agree with the recent change in the USPSTF guidelines,” says Dr. Lonier. “Prediabetes and type 2 diabetes are highly prevalent. Detecting prediabetes at younger ages will allow more people to implement lifestyle changes that can prevent progression of prediabetes to overt type 2 diabetes.”
How can early detection help?
“The benefits to earlier detection are potentially preventing progression of prediabetes to type 2 diabetes, and beginning treatment for overt type 2 diabetes earlier in the disease course, which may help prevent the onset of long term diabetes complications,” Dr. Lonier says.
Over time, diabetes can cause serious health conditions, like heart disease, according to the CDC. Diabetes is also the leading cause of kidney failure and new cases of blindness among adults, and increases the risk for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, according to the JAMA article.
Once diagnosed, patients can make moves to alter their day-to-day and improve their nutrition, activity, overall body fat and muscle mass, and take medications if needed, agrees Dr. Fruge. “The sooner the issue is discovered, the more time they have and the easier it is to improve,” she says.
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