Diabetes mellitus type 2 screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Diabetes screening is recommended for many people at various stages of life, and for those with risk factors. Screening tests are the same tests used for diagnosis. Early diagnosis and treatment can control the complications and result in better clinical outcomes.

Screening

• Screening is recommended for persons at risk of developing diabetes, starting at the age 45 years.

American Diabetes Association

Criteria for testing for diabetes or prediabetes in asymptomatic adults
Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors: A1C  ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing First-degree relative with diabetes High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) Women who were diagnosed with GDM History of CVD Hypertension ( ≥140/90 mmHg or on therapy for hypertension) HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) Women with polycystic ovary syndrome Physical inactivity Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).
For patients at risk, testing should begin at the age of 45 years.
If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.

• To decrease the risk of developing type 2 diabetes in pregnant women after pregnancy, they should be screened for early detection of diabetes according to the following guidelines:

American College of Obstetricians and Gynecologists (ACOG)

It has been estimated that 15-50% of gestational diabetes mellitus-diagnosed mothers will go on to develop T2DM postpartum. Consequently, ACOG guidelines currently recommend the following screening methods for T2DM detection:

• 75g 2-hr oral glucose tolerance test (OGTT)

OR

• Fasting plasma glucose at 6-12 weeks postpartum

Fifth International Workshop-Conference on GDM & American Diabetic Association

Data has been presented that estimates only 34% of women with IGT or type 2 diabetes had impaired fasting glucose and that 44% of those with type 2 diabetes had fasting levels 100 mg/day (5.5 mmol/l) during their postpartum visit. Given this risk, it has been suggested by this symposium in conjunction with the ADA that regardless of the 6-12 week screening result, GDM-diagnosed mothers ought to undergo the following screening strategy:

• Post-delivery (1–3 days): Fasting or random plasma glucose
• Early postpartum (6-12 weeks postpartum): 75-g 2-h OGTT
• 1 year postpartum: 75-g 2-h OGTT
• Annually: Fasting plasma glucose
• Tri-annually: 75-g 2-h OGTT
• Prepregnancy: 75-g 2-h OGTT

Benefit of Early Detection

• Following the publication of the USPSTF statement, a randomized controlled trial was done and acarbose was prescribed to patients in the "high-risk population" between the ages of 40 and 70 years, whose body mass index (calculated as weight in kilograms divided by the square of height in meters) fell between 25 and 40 kg/m². They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L). The trial revealed a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event.

• Other studies have shown that life-style changes and metformin can delay the onset of diabetes.