Recommended Diabetes Screenings Overlook Many Patients

By Jane Farrell

The latest guidelines for diabetes screening may not be working so well. In a narrow view of the clinical recommendations made by the United States Preventive Task Force, researchers from Northwestern Medicine found that those guidelines missed 55 percent of high-risk patients who had diabetes or prediabetes.

The 2015 screening guidelines from the USPSTF  — an independent, volunteer panel of national experts in prevention and evidence-based medicine — recommended that patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. The Northwestern Medicine study found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.

Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications. This is the first study to examine how the new USPSTF guidelines may perform in practice.

Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out of pocket.

“Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly,” said study senior author Dr. Matthew O’Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes.”

The study was published in PLOS Medicine.

Fifty-four percent of white patients who developed dysglycemia fell within the screening guidelines, compared to only 50 percent of African-American patients and 37 percent of Latino patients, according to the study.

“Say I’m caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy. She shouldn’t be screened, according to the guidelines, but she’s very likely to have either prediabetes or diabetes,” O’Brien said.

The study looked at electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.

O’Brien said the USPSTF is on the right track with their guidelines because they focus on the two risk factors — age and weight — that are most predictive of developing dysglycemia. However, physicians should be aware of this study’s findings, so they can understand who may be missed by the USPSTF’s criteria and decide whether to screen those patients, he said.

With these findings, O’Brien said next steps are to decide what other factors should be taken into account when determining who is at risk for diabetes and to use electronic health records to automatically prompt providers to screen patients who have those risk factors.