“It really makes sense to start screening earlier,” says Chien-Wen Tseng, MD, MPH, a member of the USPSTF, which helped develop the updated recommendations. “Many people don’t know they have prediabetes or type 2 diabetes, because they’re not aware of the symptoms or don’t have any symptoms. Screening is a safe, effective way to find out and, with prediabetes, make lifestyle changes” that prevent the progression to the full-blown condition, says Dr. Tseng, who is also the Hawaii Medical Service Association endowed chair in health services and quality research. The update comes as rates for both diabetes and obesity continue to increase, according to the Centers for Disease Control and Prevention (CDC). An estimated 13 percent of U.S. adults have diabetes (most of them being type 2), and 34.5 percent meet the criteria for prediabetes, according to the task force’s recommendation statement, which was published in the August 2021 issue of the Journal of the American Medical Association (JAMA). In 2017–2018, the U.S. obesity rate was 42.4 percent, per the CDC. RELATED: The Prediabetes Diet Everyone Should Follow
Benefits of Early Screening for Diabetes
It’s possible to live with type 2 diabetes for years without knowing it, the Mayo Clinic points out. When symptoms do develop, they include increased thirst, frequent urination, increased hunger, fatigue, blurred vision, and frequent infections. Prediabetes, which leads to type 2 diabetes if average blood sugar levels (referred to as A1C) don’t come down, usually doesn’t cause any symptoms, Mayo Clinic notes. According to the USPSTF, overweight and obesity as defined by BMI are the strongest risk factors for adults to develop prediabetes and type 2 diabetes. Age is another risk factor: The organization says that the incidence of diabetes increases at age 35, compared with younger ages. That’s why the USPSTF adjusted its screening recommendation, Tseng says. It’s crucial to know whether you have prediabetes, because lifestyle interventions, such as adopting a healthy diet or exercise regimen, can essentially act as a stop sign preventing type 2 diabetes from moving forward. “There are measures you can take to help lower your risk or manage type 2 diabetes,” says Toby Smithson, RDN, CDCES, who’s based in Hilton Head, South Carolina. She’s a diabetes lifestyle expert with DiabetesEveryDay and the author of Diabetes Meal Planning and Nutrition for Dummies. “The good news is that you have the power to self-manage your health in this instance.” Smithson notes that research from the Diabetes Prevention Program trials has shown that by adding 150 minutes of exercise per week and achieving 7 percent weight loss, more than half of high-risk participants were able to reduce their chance of developing type 2 diabetes. “As a diabetes educator, I applaud earlier screening because knowledge is power,” Smithson says. “For some people, a screening may be the nudge they need to take charge and adjust their lifestyle decisions.” Among those who already have type 2 diabetes, early screening can prevent serious complications of diabetes, such as long-term damage of the kidneys, heart, and blood vessels. In its new recommendation, the USPSTF notes that there’s evidence that interventions for newly diagnosed diabetes — such as taking the drug metformin, which helps control high blood sugar — can help reduce death from any cause, while also lowering the risk of a heart attack after 10 to 20 years. Caroline Messer, MD, a New York City–based endocrinologist with Fifth Avenue Endocrinology, says early screening should be the “standard of care,” even in people younger than 35. If she sees a patient who’s 14 and overweight, for example, she screens him for diabetes. “If somebody had never been screened until they were 35, it would really strike me as an oversight,” she says. “It’s not like a colonoscopy where it’s like, okay, you’re 45, let’s go.” RELATED: Obesity Tied to Type 2 Diabetes Risk Even Without Genetic Predisposition
What to Expect During a Diabetes Screening
There are two simple ways to screen for prediabetes and type 2 diabetes, Tseng says. If a patient has fasted ahead of their visit, she does a finger prick to check fasting blood sugar level. A normal fasting blood sugar level is 99 milligrams per deciliter (mg/dL) or lower, while 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes, according to the CDC. Another way to screen is by doing a blood draw to find out a patient’s A1C, which is a measure of average blood sugar level over the previous few months. An A1C below 5.7 percent is normal, according to the CDC, while a level that’s between 5.7 percent and 6.4 percent indicates prediabetes. If your A1C is higher than 6.5 percent, you likely have diabetes. “These are really low-cost options, and it’s foolish not to do these really cheap tests,” Dr. Messer says. When a screening test indicates a patient has type 2 diabetes, she typically starts by giving that person a few months in which to make lifestyle changes. “I say to them, ‘I want you to go on a low-carb diet,’” she says. “I’ll teach them all about starchy carbs and avoiding juices, sugary drinks, and dessert. We’ll go through the whole diet and then I’ll have them do aerobic exercise.” If the person’s levels are still elevated after three months, she usually starts them on metformin. Depending on how extreme the situation is, the patient might need insulin. If you have overweight or obesity and are 35 or over, Tseng implores you to ask your doctor to screen you for diabetes. “It’s really one of the best ways to take care of your health,” she says. “Diabetes is a leading cause of death, and so much of this is potentially preventable. Knowing whether or not somebody has prediabetes or diabetes can make a huge difference down the line, 10 or 20 or 30 years later.” RELATED: How Is Type 2 Diabetes Diagnosed?
