Overweight adults should be screened for diabetes at 35, experts say

Overweight adults should be screened for Type 2 diabetes and abnormally high blood sugar levels starting at age 35, five years earlier than currently advised, an expert task force recommended on Tuesday.

The new recommendation, which does not apply to pregnant women, comes amid cresting rates of obesity and diabetes in the United States. It means that more than 40 percent of the adult population should now be screened, according to one estimate.

The guideline was issued by the US Preventive Services Task Force, which makes recommendations for preventive services and screenings that insurance companies must completely cover, without out of pocket costs to the insured, under the Affordable Care Act.

The task force’s recommendation and a summary of the latest scientific evidence were published on Tuesday in the journal JAMA.

Nearly one in seven American adults now has diabetes, the highest rate on record, a recent study found. There has been little improvement over the past decade in patients’ ability to manage the condition, keeping in check their blood sugar levels, blood pressure and cholesterol.

The increase is especially troubling amid the pandemic, as diabetes is one of the chronic medical conditions that increase the risk that a coronavirus infection will lead to severe illness, hospitalization or even death.

Diabetes is linked to heart disease and liver disease, and it is the leading cause of kidney failure and new blindness in adults. The condition can lead to limb amputation, nerve damage and other complications.

The task force said health care providers should consider screening some individuals even earlier than age 35 if they are at heightened risk. Those include people with a family history of diabetes or a personal history of conditions like gestational diabetes, and people who are Black, Hispanic, Native American, Alaska Native or Asian American.

All of these groups have higher rates of diabetes than white Americans.

“The COVID epidemic is really important, but we also have an epidemic of diabetes and pre-diabetes driven by the epidemic of obesity and lack of exercise,” said Dr Michael J Barry, the vice chair of the task force who directs the informed medical decisions program at Massachusetts General Hospital in Boston. “All these conditions that we’ve lived with for years are still out there.”

About one-third of US adults have high blood sugar levels, a condition called pre-diabetes that often precedes Type 2 diabetes and can progress to full blown disease. Most are unaware they have the condition, which doesn’t produce obvious symptoms and is why screening is essential, Barry said.

Being overweight or obese is the most important risk factor for the most common type of diabetes, Type 2 diabetes, and for pre-diabetes. Lifestyle changes — including increasing physical activity, eating a healthier diet and losing even a modest amount of weight — can prevent the progression from pre-diabetes to full diabetes. (Drug treatment is also an option.)

Screening generally involves a blood test to determine whether blood sugar (or glucose) is elevated. The task force called for lowering the age of first screening to 35 because that is when the prevalence of Type 2 diabetes starts to inch upward. Screening should be carried out every three years until age 70, the task force said.

Dr Tannaz Moin, an endocrinologist who co-wrote an editorial accompanying the new recommendations, said that lowering the age for screening was a step in the right direction, and that she was pleased that the guidelines emphasized the importance of detecting pre-diabetes.

“There’s a lot more recognition that pre-diabetes is a big problem that often flies under the radar,” she said. It is critical to detect pre-diabetes in younger adults, because they may live with diabetes for a long time if they develop it at a relatively young age, and will be at a greater risk of developing complications.

Intensive lifestyle interventions that focus on moderate weight loss and include 150 minutes of physical activity per week can prevent or delay the onset of Type 2 diabetes in overweight or obese people with pre-diabetes. A drug, metformin, is also an option but is not as beneficial as lifestyle changes.

“We have really good evidence that we can delay the onset of Type 2 diabetes if we get individuals who have pre-diabetes to do something about their risk,” Moin said. “It’s the same for people with Type 2 diabetes: Once we know they have it, we have a whole toolbox of things we can offer them.”

Rates of diabetes and pre-diabetes have increased in recent years among younger populations, including children and teenagers. Studies have shown that almost one in four adults ages 18 to 44 has pre-diabetes.

Another study published on Tuesday in JAMA reported that the prevalence of both Type 1 diabetes, often called juvenile diabetes, and Type 2 diabetes, which generally starts later in life, increased in children and teenagers from 2001 to 2017, with the greatest increases among those ages 16 and over.

The rate of Type 2 diabetes nearly doubled, to 0.67 per 1,000 Americans ages 10 to 19 in 2017 from 0.34 per 1,000 young people in 2001. The greatest increases were reported among Black and Hispanic youngsters.

The incidence of Type 1 diabetes also increased, to 2.15 per 1,000 children and teenagers under age 19 in 2017 from 1.48 per 1,000 in 2001, with the greatest increases among white and Black children and teenagers.

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