Public Release: 

New US recommendation for diabetes screening may miss ethnic minority groups

PLOS

In response to the worldwide diabetes epidemic, many countries are focusing healthcare efforts in order to improve evidence-based diabetes prevention and treatments. In 2015, the United States Preventive Services Task Force (USPSTF), an independent group of clinical experts whose work is supported by the U.S. government, issued a new recommendation to screen adults aged 40-70 years old who are overweight or obese for dysglycemia (a term used to describe those with either diabetes or prediabetes). In a study published in PLOS Medicine, as part of the Preventing Diabetes special issue which is Guest Edited by Professors Nick Wareham and William Herman, Matthew O'Brien (Northwestern University, USA) and colleagues present the results of their cohort analysis to determine the effectiveness of this screening program. Surprisingly, they show that this approach may only detect half of adults with undiagnosed dysglycemia; worryingly, this detection rate drops for racial or and ethnic minorities, compared to whites.

The authors conducted a retrospective analysis of electronic health records for 50,515 adult patients receiving primary care in 6 large community health centres in the Midwest and Southwest. Only 12,679 of the patients actually fulfilled the USPSTF criteria for screening. The authors show that of the 29,946 patients who completed a screening test within the three-year follow up period, 8,478 developed dysglycemia. Only 45% of these patients with dysglycemia would have been identified by the new USPSTF criteria. In addition, dysglycemia is less likely to be identified in minority patients. Among those who developed dysglycemia, the screening criteria detected 54.5% of whites, compared to 50.3% of Blacks and 37.7% of Hispanic/Latino patients. This difference reflects that more patients within these groups develop dysglycemia at a normal weight or aged under 40, relative to whites.

By reporting on the limited effectiveness of this screening program, this study raises concerns about the program's broad utility, particularly among racial and ethnic minority groups. Primary care providers may need to consider screening minority patients who are younger than 40 years old and have a normal weight. There may be economic consequences as health insurance providers may decide not to fund screening outside of this USPSTF recommendation, which could pass the full cost of testing onto patients.

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Research Article

Funding:

We acknowledge the funders of this study: the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (K23DK095981; http://www.niddk.nih.gov/; MJO), the Agency for Healthcare Research and Quality (P01HS21141; http://www.ahrq.gov/), and the Chicago Center for Diabetes Translation Research (P30DK092949; http://chicagodiabetesresearch.org/pilot-and-feasibility-grants/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

O'Brien MJ, Lee JY, Carnethon MR, Ackermann RT, Vargas MC, Hamilton A, et al. (2016) Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med 13(7): e1002074. doi:10.1371/journal.pmed.1002074

Author Affiliations:

Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Alliance of Chicago Community Health Services, L3C, Chicago, Illinois, United States of America
Erie Family Health Center, Chicago, Illinois, United States of America
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America

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Contact

Matthew O'Brien
Assistant Professor of Medicine
Northwestern University
Feinberg School of Medicine
750 N. Lake Shore Drive
Chicago, IL 60611
UNITED STATES
312-503-5046
matthew.obrien1@northwestern.edu

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