Age, not weight, should be the big decider in whether to screen for diabetes

Because it’s possible to be diabetic or prediabetic without any symptoms, and early diagnoses lead to better health outcomes, lots of countries have screening programs for diabetes.

In the US, overweight or obese people between 35 and 70 are recommended to regularly get diabetes tests.

But new research in the American Journal of Preventative Medicine has called this into question, suggesting that screening based purely on age will catch the greatest proportion of diabetic and prediabetic people.

“It might sound counterintuitive because we think of being overweight or obese as the primary cause of diabetes,” says lead author Dr Matthew O’Brien, an associate professor of medicine at Northwestern University Feinberg School of Medicine, US.

“But if we make decisions about diabetes testing based on weight, we will miss some people from racial and ethnic minority groups who are developing prediabetes and diabetes at lower weights.”

The researchers examined data from all the 2021 diabetes screenings recommended by the US Preventive Services Task Force. Based on this data, they recommend screening every US adult aged between 35 and 70.

“All major racial and ethnic minority groups develop diabetes at lower weights than white adults, and it’s most pronounced for Asian Americans,” says O’Brien.

Read more: Unlocking blood glucose regulation in people with diabetes

Roughly half of US adults have Type 2 diabetes or prediabetes, and 81% of adults with prediabetes don’t know they have it. Diagnoses are delayed in ethnic minorities, compared to white people.

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

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

The researchers also found that it might be beneficial for members of some ethnic minorities to receive earlier screening, but they don’t formally recommend it.

“It’s imperative that we identify a screening approach that is equitable across the entire US population,” says O’Brien.

“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.”

This age cut-off also makes it much simpler for clinicians to decide whether someone should get a diabetes test.

“There are many ways to nudge patients and providers to complete this testing, which should be the focus of future research,” says O’Brien.

In Australia, diabetes tests are recommended based on a range of risk factors, including age, waist measurement, ethnicity, physical activity and family history. Diabetes Australia has a risk calculator with which you can determine your own risk.

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