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U.S. Preventive Services Task Force Criteria for Diabetes Screening

Time to Revisit the Evidence?
      The U.S. population currently suffers from a serious epidemic of obesity and diabetes, with growing public health and economic implications.

      American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033–46.

      Evidence-based strategies are available to both prevent new-onset diabetes
      • Pan X.R.
      • Li G.W.
      • Hu Y.H.
      • et al.
      Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.
      • Tuomilehto J.
      • Lindström J.
      • Eriksson J.G.
      and the Finnish Diabetes Prevention Study Group
      Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
      • Knowler W.C.
      • Barrett-Connor E.
      • Fowler S.E.
      • et al.
      the Diabetes Prevention Program Research Group
      Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
      • Ramachandran A.
      • Snehalatha C.
      • Mary S.
      • Mukesh B.
      • Bhaskar A.D.
      • Vijay V.
      the Indian Diabetes Prevention Programme (IDPP)
      The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
      and to control it, thereby reducing the risk of long-term complications.
      • Holman R.R.
      • Paul S.K.
      • Bethel M.A.
      • Matthews D.R.
      • Neil H.A.
      10-year follow-up of intensive glucose control in type 2 diabetes.
      Indeed, diabetes control has improved over the last 2 decades.

      Casagrande SS, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care 2013 Feb 15 [Epub ahead of print].

      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, exacerbated by the increasing prevalence of diabetes. Furthermore, a significant proportion of patients have established complications at diagnosis. This suggests that we are neither implementing proven prevention strategies effectively in those at risk nor effectively treating the hyperglycemia before a legacy of tissue damage is established.
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