Screening
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Diabetes Mellitus Type 2Published by: Domus Medica | SSMGLast published: 2017Diabète sucré de type 2Published by: SSMG | Domus MedicaLast published: 2017Hemoglobin A1c (HbA1c), fasting plasma glucose, and plasma glucose 2 hours after 75 g oral glucose are all appropriate screening tests.[2]
US Preventive Services Task Force screening criteria
The US Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in adults ages 35-70 years who have overweight (BMI ≥25 kg/m² or ≥23 kg/m² for Asian-Americans) or obesity (BMI ≥30 kg/m²).[96] Screening should be considered at an earlier age in patients from a population with a disproportionately high prevalence of diabetes (American Indian/Alaska Native, Black, Hawaiian/Pacific Islander, Hispanic/Latino).[96] The weight threshold is lower for Asian-Americans than other ethnicities as data indicate a higher risk in this population at lower body mass indexes. Those with normal test results should be re-screened every 3 years. Those who have prediabetes should be referred for effective preventive interventions.[96]
American Diabetes Association (ADA) screening criteria
Testing should be considered in nonpregnant asymptomatic adults of any age with BMI ≥25 kg/m² (≥23 kg/m² for Asian-Americans) in the presence of one or more of the following risk factors:[2]
A history of diabetes in a first-degree relative
Physical inactivity
African-American, Latino, Native-American, Asian-American, or Pacific Islander ancestry
Hypertension (≥130/80 mmHg or on therapy for hypertension)
Dyslipidemia (high-density lipoprotein cholesterol <35 mg/dL [<0.90 mmol/L] and/or triglycerides >250 mg/dL [>2.82 mmol/L])
Cardiovascular disease
Polycystic ovary syndrome
Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans).
People with prediabetes (HbA1c ≥5.7% [≥39 mmol/mol], impaired glucose tolerance, or impaired fasting glucose) should be tested yearly.
People who have a history of gestational diabetes mellitus should have lifelong testing at least every 3 years.
For all other people, testing should begin at age 35 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 and risk status.
Consider screening for prediabetes or diabetes in people taking certain drugs, such as corticosteroids, statins, thiazide diuretics, some HIV antiretrovirals, and second-generation antipsychotics, as these agents are known to increase the risk of these conditions. People with HIV should be screened for diabetes and prediabetes with a fasting glucose test before antiretroviral therapy, at the time of switching antiretroviral therapy, and 3-6 months after starting or switching antiretroviral therapy. If initial screening is normal, fasting glucose should be checked annually. HbA1c should not be used to diagnose diabetes in people with HIV. People who are prescribed second-generation antipsychotics should be screened for prediabetes and diabetes at baseline. Testing should be repeated 12-16 weeks after initiation or sooner, if clinically indicated, and annually.
Preconception, pregnancy screening for undiagnosed diabetes
The ADA recommends preconception screening for undiagnosed diabetes in all women at increased risk for type 2 diabetes (due to the presence of risk factors as outlined above) who are planning a pregnancy.[2] For those who were not screened preconception, it recommends that patients at increased risk for type 2 diabetes be screened within the first 15 weeks of pregnancy (i.e., at their first prenatal visit) with an HbA1c or a fasting blood glucose using standard diagnostic criteria.[2]
The American College of Obstetricians and Gynecologists (ACOG) advises that screening for undiagnosed (pregestational) type 2 diabetes should be undertaken before 24 weeks of gestation, preferably at the onset of prenatal care, in patients with risk factors.[97] It comments that there are insufficient data to support the best screening modality for pregestational diabetes in pregnancy, but consideration can be made to use the same diagnostic criteria as for the nonpregnant population (HbA1c ≥6.5% [≥48 mmol/mol], or fasting plasma glucose ≥126 mg/dL [≥7.0 mmol/L], 2-hour plasma glucose value ≥200 mg/dL [≥11.1 mmol/L] 2 hours after 75 g oral glucose, or random plasma glucose ≥200 mg/dL [≥11.1 mmol/L] in patients with classic hyperglycemia symptoms), understanding the limitations of these criteria because they have not been validated in pregnancy.[97]
An alternative approach is to perform preconception screening in all women of childbearing potential (universal screening), which may be increasingly appropriate in populations with a high prevalence of risk factors and/or undiagnosed diabetes. Likewise, universal screening for undiagnosed type 2 diabetes may be considered at the first prenatal visit for all women, assuming they have not already been screened preconception.[2]
Postpartum screening
All women who have been diagnosed with gestational diabetes in the current pregnancy should be screened for type 2 diabetes in the postpartum period. ACOG and the ADA recommend screening with an oral glucose tolerance test; this can be performed either in the immediate postpartum period (during the delivery hospitalization) or at 4-12 weeks postpartum.[2][97] Given the low rates of oral glucose tolerance test uptake, screening with HbA1c or fasting glucose should be considered within the first year postpartum for those who do not complete an oral glucose tolerance test.[42] Screening should be repeated every 1-3 years depending on whether results are abnormal.[2][42]
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