Screening for Dysglycemia: Connecting Supply and Demand to Slow Growth in Diabetes Incidence

Impact of changes in diabetes screening guidelines on testing eligibility and potential yield among adults without diagnosed diabetes in the United States

AIMS

Recent USPSTF and ADA guidelines expanded criteria of whom to test to identify prediabetes and diabetes. We described which Americans are eligible and report receiving glucose testing by USPSTF 2015 and 2021 as well as ADA 2003 and 2022 recommendations, and performance of each guideline.

METHODS

We analyzed cross-sectional data from 6,007 non-pregnant U.S. adults without diagnosed diabetes in the 2013-2018 National Health and Nutrition Examination Surveys. We reported proportions of adults who met each guideline's criteria for glucose testing and reported receiving glucose testing in the past three years, overall and by key population subgroups,. Defining prediabetes (FPG 100-125 mg/dL and/or HbA1c 5.7-6.4 %) or previously undiagnosed diabetes (FPG ≥ 126 mg/dL and/or HbA1c ≥ 6.5 %), we assessed sensitivity and specificity.

RESULTS

During 2013-2018, 76.7 million, 90.4 million, 157.7 million, and 169.5 million US adults met eligibility for glucose testing by USPSTF 2015, 2021, and ADA 2003 and 2022 guidelines, respectively. On average, 52 % of adults reported receiving glucose testing within the past 3 years. Likelihood of receiving glucose testing was lower among younger adults, men, Hispanic adults, those with less than high school completion, those living in poverty, and those without health insurance or a usual place of care than their respective counterparts. ADA recommendations were most sensitive (range: 91.0 % to 100.0 %) and least specific (range: 18.3 % to 35.3 %); USPSTF recommendations exhibited lower sensitivity (51.9 % to 66.6 %), but higher specificity (56.6 % to 74.5 %).

CONCLUSIONS

An additional 12-14 million US adults are eligible for diabetes screening. USPSTF 2021 criteria provide balanced sensitivity and specificity while ADA 2022 criteria maximize sensitivity. Glucose testing does not align with guidelines and disparities remain.

Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community

Introduction

A project in a Texas border community setting, Prevention Organized against Diabetes and Dialysis with Education and Resources (POD²ER), offered diabetes prevention information, screening, and medical referrals. The setting was a large, longstanding flea market that functions as a shopping mall for low-income people. The priority population included medically underserved urban and rural Mexican Americans. Components of the program addressed those with diabetes, prediabetes, and accompanying relatives and friends.

Background

People living in the Lower Rio Grande Valley (LRGV) face challenges of high rates of type 2 diabetes, lack of knowledge about prevention, and inadequate access to medical care. Recent statistics from actual community-wide screenings indicate a high diabetes prevalence, 30.7% among adults in the LRGV compared with 12.3% nationwide.

Methods

A diverse team composed of public health faculty, students, a physician, a community health worker, and community volunteers conceived and developed the project with a focus on cultural and economic congruence and a user-friendly atmosphere. The program provided screening for prediabetes and diabetes with a hemoglobin A1c test. Screening was offered to those who were at least 25 years of age and not pregnant. When results indicated diabetes, a test for kidney damage was offered (urinary albumin-to-creatinine ratio). A medical appointment at a community clinic within a week was provided to those who tested positive for diabetes and lacked a medical home. Health education modules addressed all family members.

Discussion

The project was successful in recruiting 2,332 high-risk people in 26 months in a community setting, providing clinic referrals to those without a doctor, introducing them to treatment, and providing diabetes prevention information to all project participants. Implications for research and practice are highlighted.

Conclusion

This study shows that a regular access point in a place frequented by large numbers of medically marginalized people in a program designed to eliminate cultural and economic barriers can succeed in providing a hard-to-reach community with diabetes prevention services. Aspects of this program can serve as a model for other service provision for similar populations and settings.

Risk Score for Detecting Dysglycemia: A Cross-Sectional Study of a Working-Age Population in an Oil Field in China

Background

Dysglycemia (pre-diabetes or diabetes) in young adults has increased rapidly. However, the risk scores for detecting dysglycemia in oil field staff and workers in China are limited. This study developed a risk score for the early identification of dysglycemia based on epidemiological and health examination data in an oil field working-age population with increased risk of diabetes.

Material/Methods

Multivariable logistic regression was used to develop the risk score model in a population-based, cross-sectional study. All subjects completed the questionnaires and underwent physical examination and oral glucose tolerance tests. The performance of the risk score models was evaluated using the area under the receiver operating characteristic curve (AUC).

Results

The study population consisted of 1995 participants, 20–64 years old (49.4% males), with undiagnosed diabetes or pre-diabetes who underwent periodic health examinations from March 2014 to June 2015 in Dagang oil field, Tianjin, China. Age, sex, body mass index, history of high blood glucose, smoking, triglyceride, and fasting plasma glucose (FPG) constituted the Dagang dysglycemia risk score (Dagang DRS) model. The performance of Dagang DRS was superior to m-FINDRISC (AUC: 0.791; 95% confidence interval (CI), 0.773–0.809 vs. 0.633; 95% CI, 0.611–0.654). At the cut-off value of 5.6 mmol/L, the Dagang DRS (AUC: 0.616; 95% CI, 0.592–0.641) was better than the FPG value alone (AUC: 0.571; 95% CI, 0.546–0.596) in participants with FPG <6.1 mmol/L (n=1545, P=0.028).

Conclusions

Dagang DRS is a valuable tool for detecting dysglycemia, especially when FPG <6.1 mmol/L, in oil field workers in China.