Diabetes

Diabetes

• National Guidelines and Recommendations
• Professional Groups
• Advocacy Groups

National Guidelines and Recommendations

Family history of diabetes has been recognized as an important risk factor of the disease. Family medical history represents valuable genomic information because it characterizes the combined interactions between environmental, behavioral and genetic factors.

Reference: Family History, Diabetes, and Other Demographic and Risk Factors Among Participants of the National Health and Nutrition Examination Survey 1999-2002 [PubMed Central]

U.S. Preventive Services Task Force (USPSTF) Guidelines

Screening for Type 2 Diabetes Mellitus in Adults:
Regardless of whether the clinician and patient decide to screen for diabetes, patients should be encouraged to exercise, eat a healthy diet, and maintain a healthy weight, choices that may prevent or forestall the development of type 2 diabetes.

More aggressive interventions to establish and maintain these behaviors should be considered for patients at increased risk for developing diabetes, such as those who are overweight, have a family history of diabetes, or have a racial or ethnic background associated with an increased risk (e.g., American Indians). Intensive programs of lifestyle modification (diet, exercise, and behavior) should also be considered for patients who have impaired fasting glucose or impaired glucose tolerance, since several large trials have demonstrated that these programs can significantly reduce the incidence of diabetes in these patients.

Evidence and recommendations regarding counseling about diet, physical activity and obesity are provided in the USPSTF evidence summaries:

• Behavioral Counseling to Promote a Healthy Diet [uspreventiveservicestaskforce.org]
• Behavioral Counseling to Promote Physical Activity [uspreventiveservicestaskforce.org]
• Screening and Interventions to Prevent Obesity in Adults [uspreventiveservicestaskforce.org] available on the Agency for Healthcare Research and Quality [ahrq.gov] website.

Reference: Screening for Type 2 Diabetes Mellitus in Adults [uspreventiveservicestaskforce.org]

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Diabetes Risk in American Indians and Alaska Natives

According to a press release from NIDDK, about 40 percent of adults age 40-74 have pre-diabetes (NIDDK Press Office, 2004). Some people have no symptoms. American Indians and Alaska Natives on average are 2.2 times more likely to experience diabetes than Caucasians. Recognizing those at increased risk because of a family history or ethnicity may help prevent devastating complications.

• National Diabetes Education Program: Your Game Plan for Prevention of Type 2 Diabetes [ndep.nih.gov] (2003)

Professional Organizations

American Academy of Family Physicians -Diabetes, Type 2

The AAFP recommends screening for type 2 diabetes in adults with hypertension and hyperlipidemia. There is insufficient evidence to recommend for or against screening adults who are at low risk for coronary vascular disease.

Clinical Consideration: Screening for Diabetes Mellitus, Adult type 2 [uspreventiveservicestaskforce.org]

Reference: Recommendations for Clinical Preventive Services [aafp.org]

American College of Physicians

Diabetes Risk Information: You may be at risk to get type 2 diabetes if you:

• Are over age 45
• Have a family history of diabetes
• Are overweight
• Do not exercise regularly
• Have had gestational diabetes
• Have high blood pressure or high cholesterol
• Are African American, American Indian, Asian American, Hispanic or Pacific Islander

Reference: Diabetes [acponline.org]

American Society of Clinical Endocrinologists: Facts About Diabetes

Risk for Diabetes:
Race and ethnicity: African Americans are twice as likely as whites to be diagnosed and die from diabetes. Latino/Hispanic Americans have one of the highest prevalence rates in the world. Native Americans and Asian Americans also have a substantially increased risk for diabetes.

Reference: Facts about Diabetes [aace.com]

Advocacy Groups

American Diabetes Association

Criteria for Testing for Diabetes in Asymptomatic Adult Individuals

Testing should be considered at a younger age or be carried out more frequently in individuals who are overweight (BMI >25 kg/m2*) and have additional risk factors:

• Are habitually physically inactive
• Have a first-degree relative with diabetes
• Are members of a high-risk ethnic population (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
• Have delivered a baby weighing >9 lb or have been diagnosed with gestational diabetes mellitus (GDM)
• Are hypertensive (>140/90 mmHg)
• Have a high-density lipoprotein (HDL) cholesterol level 35 mg>250 mg/dL (2.82 mmol/L)
• Have polycystic ovary syndrome (PCOS)
• On previous testing, had impaired glucose tolerance or impaired fasting glucose
• Have other clinical conditions associated with insulin resistance (e.g., PCOS, acanthosis nigricans)
• Have a history of vascular disease

Criteria for Testing for Type 2 Diabetes in Children

Overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) plus any two of the following risk factors:

• Family history of type 2 diabetes in first or second-degree relative
• Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander)
• Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, or PCOS)
• Maternal history of diabetes or gestational diabetes mellitus

 

Age of Initiation:

• Age 10 years or at onset of puberty, if puberty occurs at a younger age

Frequency:

• Every 2 years

Testing

• Test fasting plasma glucose preferred

Reference: Standards of medical care in diabetes [guidelines.gov]
(Section II: Testing for prediabetes and diabetes in asymptomatic patients)