US Screening Guidelines Fail To Detect Disproportionate Number of Minorities With Diabetes or Pre-Diabetes Interview with:

Matthew James O'Brien MD Northwestern University Feinberg School of Medicine

Dr. Matthew James O’Brien

Matthew James O’Brien MD
Northwestern University Feinberg School of Medicine What is the background for this study?

Response: In October 2015, the United States Preventive Services Task Force (USPSTF) released new diabetes screening guidelines. This government-supported expert group recommended screening asymptomatic adults who are 40-70 years old and overweight or obese for diabetes. Recent population trends show that racial/ethnic minorities develop diabetes at younger ages and lower weights than whites. Therefore, we sought to determine whether these screening criteria may fail to identify racial/ethnic minorities or other high-risk population subgroups. Our study population was 50,515 patients from federally-funded community health centers, which serve large numbers of minorities and socioeconomically disadvantaged individuals. What are the main findings?

Response: To our knowledge, this is the first study to examine the performance of the new USPSTF diabetes screening guideline. There are 2 main findings from our study, which are both potentially concerning.

First, these criteria only identified 45% of adults who had prediabetes or diabetes.

And second, racial/ethnic minorities were at higher risk for developing prediabetes and diabetes relative to whites, yet were less likely to be identified by these new screening criteria. What should readers take away from your report?

Response: By missing a substantial proportion of adults with prediabetes and diabetes, this screening guideline may delay effective treatments to prevent or control diabetes. The fact that racial/ethnic minorities are less likely to be identified by the screening criteria than whites raises concern that implementing this guideline may contribute to racial/ethnic disparities in diabetes. These findings suggest that doctors should consider screening patients for diabetes who do not fall within the age- and weight-based criteria defined by this guideline, especially racial/ethnic minorities. However, if patients who do not meet these USPSTF criteria have a diabetes screening test, they may have to pay for it out-of-pocket. What recommendations do you have for future research as a result of this study?

Response: We need future research to examine the performance of the same screening criteria in a nationally representative population. In addition, future prospective studies should examine the use of these guidelines in practice to examine their impact on diabetes-related outcomes and racial/ethnic disparities in diabetes. Is there anything else you would like to add?

Response: The USPSTF was on the right track by focusing their guideline on the two most important risk factors for diabetes—age and weight. Our study provides the first evidence describing who may be missed by only screening adults with these two risk factors.


O’Brien MJ, Lee JY, Carnethon MR, Ackermann RT, Vargas MC, Hamilton A, et al. (2016) Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med 13(7): e1002074. doi:10.1371/journal.pmed.1002074

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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