Study: Use Age to Screen for Diabetes and Close, Ethnic, Racial Barriers for Prediabetes

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Age, not weight, could be used to help identify individuals of all ethnic and racial groups with prediabetes and diabetes, according to the results of a study from Northwestern Medicine.

“All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans,” Matthew O’Brien, MD, an associate professor of medicine at Northwestern University Feinberg School of Medicine, said in a statement.

screening all adults aged 35 to 70 years, regardless of weight, could help identify the greatest proportion of individuals with diabetes and prediabetes in the United States, investigators said.

Age can also be used to maximize the ability to diagnose diabetes and prediabetes across all ethnic and racial groups.

The US Preventative Services Task Force (USPSTF) recommends screening only individuals aged 35 to 70 years who are obese or overweight.

However, this could mean missing individuals ethnic and racial minority groups who are developing diabetes and prediabetes at lower weights, O’Brien said.

Investigators of the study were the first to examine the health-equity implications of current screening recommendations.

Asian Americans often develop diabetes and prediabetes at a normal weight, investigators said.

“Diabetes is a condition in which unacceptable racial and ethnic disparities persist,” O’Brien said in the statement.

“That’s why we need a screening approach that maximizes equity. If we can find everyone earlier, it helps us reduce these disparities and the bad outcomes that follow,” O’Brien said.

This group would be most likely to be missed given the 2021 guidelines, results of the study suggested, adding that an estimated 6 million Asian Americans have prediabetes or undiagnosed diabetes.

Investigators examined the clinical performance of the 2021 USPSTF screening recommendations, as well as alternate age and body mass index (BMI) cutoffs. They assessed the entire US adult population and separately by ethnicity and race.

“It’s imperative that we identify a screening approach that is equitable across the entire [US] population,” O’Brien said. “Our findings illustrate that screening all adults aged 35 to 70 years, regardless of weight or body mass index, performs equitably across all racial and ethnic groups.”

The USPSTF also suggests that physicians consider earlier screening in ethnic and racial groups with high diabetes risk at lower BMIs or younger ages, but these alternatives were informal and not included in the recommendations.

This study was designed to evaluate options for earlier screenings that can be used for the USPSTF guidelines in the future.

Making these screening decisions based on age would also be easier for physicians to implement, investigators said.

This could also result in greater uptake of the screening approach, O’Brien said.

Future research into these screening methods should be implemented, investigators said.

The study results were published in the American Journal of Preventive Medicine. The study was also conducted in collaboration with the CDC and Emory University in Atlanta, Georgia, using nationally representative data from the National Health and Nutrition Examination Surveys.

Reference

Use age, not weight, to screen for diabetes. EurekAlert. News release. March 24, 2023. Accessed March 27, 2023. https://www.eurekalert.org/news-releases/983685