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 Those with high blood sugar but not diabetes should be sent for
intensive behavioral counseling to promote a healthy diet and
exercise that may delay or prevent the disease, the Task Force says.
In 2008, the government-backed USPSTF endorsed diabetes screening
for people with high blood pressure but couldn’t find enough
evidence to support the same screening for those who are overweight
but with no symptoms of diabetes.
Since then, six studies found that lifestyle changes to prevent or
delay diabetes are consistently beneficial, say the authors of the
new recommendation, published in the Annals of Internal Medicine.
“Any test a primary care physician would do on a healthy person can
have both potentially beneficial and potentially harmful outcomes,”
said Task Force member Dr. Michael P. Pignone of the University of
North Carolina, Chapel Hill.
“Because of that, it’s important to focus on screening tests that we
know, on balance, are effective,” Pignone told Reuters Health by
email. “The Task Force found screening adults ages 40 to 70 who are
overweight or obese can identify individuals with abnormal blood
glucose levels before it progresses to diabetes and that offering or
referring them to intensive lifestyle interventions can help prevent
or delay complications from the disease.”
The USPSTF can’t say at this point how often blood sugar screening
should occur, although computer calculations suggest that testing
every three years is reasonable, he said.
Almost 40 percent of U.S. adults have abnormal blood sugar levels
that increase diabetes risk, he said. The National Institutes of
Health, the American Heart Association and the Centers for Disease
Control and Prevention also recommend behavioral counseling on diet
and exercise for these people, he said.
Some groups may be at increased risk for diabetes even if they’re
not overweight, Pignone said, such as younger people with a family
history of diabetes, women who had diabetes while pregnant or who
have polycystic ovarian syndrome, and certain racial or ethnic
minorities including African Americans, Alaska Natives, American
Indians, Asian Americans, Hispanics or Latinos, or Native Hawaiians
and Pacific Islanders.
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“What is new here are the studies that demonstrate lifestyle
intervention can prevent or delay the progression to diabetes,” said
Dr. Shelley Selph of Oregon Health and Science University in
Portland, lead author of a review on the topic for the USPSTF in
June of 2015.
“This recommendation is important because obesity, a major risk
factor for diabetes, is common and having uncontrolled diabetes
increases one’s risk of illness and death,” Selph told Reuters
Health by email. “If we can prevent or delay progression to
diabetes, through eating a healthy diet and increasing our physical
activity, the implication is that there will be a reduced risk of
cardiovascular disease and death.”
“The American Diabetes Association recommends screening people with
multiple risk factors regardless of age,” and every patient has
unique factors that encourage or discourage diabetes screening,
Selph said. “Ideally, the physician and patient work together to
determine the appropriateness of screening.”
Doctors typically recommend weight loss through eating a healthy
diet and getting regular exercise for their patients who are
overweight, Selph said.
“The decision to refer to intensive behavioral counseling is likely
dependent on the availability of local resources and the physician’s
familiarity with those resources,” she said.
SOURCE: http://bit.ly/1i46lF7 Annals of Internal Medicine, October
26, 2015.
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