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Utility of the U.S. Preventive Services Task Force Criteria for Diabetes Screening

      Background

      Federal law requires certain private insurers to cover and waive patient cost sharing for preventive medical services that receive a grade of B or better from the U.S. Preventive Services Task Force (USPSTF). The USPSTF recommends that asymptomatic adults who have a blood pressure (BP) higher than 135/80 mmHg be screened for type 2 diabetes.

      Purpose

      The goals of this study were to determine the sensitivity and specificity of the USPSTF screening criteria and to determine the prevalence of cardiovascular risk factors and comorbidity among undiagnosed individuals by USPSTF criteria.

      Methods

      Data come from 7189 adults who participated in the 2003–2010 National Health and Nutrition Examination Survey; statistical analysis was conducted in 2011–2012. Participants with fasting plasma glucose ≥126 mg/dL or hemoglobin A1c (HbA1c) ≥6.5% who did not self-report a diagnosis of diabetes were categorized as having undiagnosed diabetes.

      Results

      Among people without diagnosed diabetes, 4.0% had undiagnosed diabetes. The proportion of adults with undiagnosed diabetes who were identified (sensitivity) using BP >135/80 mmHg as the screening standard was 44.4%; among individuals without undiagnosed diabetes, 74.8% had BP ≤135/80 mmHg (specificity). For those with undiagnosed diabetes, the prevalence of HbA1c 7.0%–<8.0% was 10.6% for those with BP ≤135/80 mmHg and 14.3% for those with BP >135/80 mmHg; and 12.8% and 9.4% for HbA1c ≥8.0%, respectively. Elevated low-density lipoprotein (100–160 mg/dL) was similar by BP cut-point (52%–53%). For those with BP ≤135/80 mmHg, 16.7% had a history of cardiovascular disease and 22.9% had chronic kidney disease.

      Conclusions

      The USPSTF screening recommendations result in missing more than half of those who have undiagnosed diabetes, and a substantial proportion of these people have increased low-density lipoprotein and other cardiovascular risk factors.
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      Linked Article

      • U.S. Preventive Services Task Force Criteria for Diabetes Screening: Time to Revisit the Evidence?
        American Journal of Preventive MedicineVol. 45Issue 2
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          The U.S. population currently suffers from a serious epidemic of obesity and diabetes, with growing public health and economic implications.1 Evidence-based strategies are available to both prevent new-onset diabetes2–5 and to control it, thereby reducing the risk of long-term complications.6 Indeed, diabetes control has improved over the last 2 decades.7 Although the rate of certain complications, such as the rate of initiation of treatment for end-stage renal disease related to diabetes, has declined with this improved control, the number of individuals affected by complications related to diabetes—including cardiovascular disease and end-stage renal disease—continues to rise,8 exacerbated by the increasing prevalence of diabetes.
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