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. 2023 Jun;64(6):814-823.
doi: 10.1016/j.amepre.2023.01.007. Epub 2023 Mar 24.

Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity

Matthew J O'Brien  1 , Yan Zhang  2 , Stacy C Bailey  3 , Sadiya S Khan  4 , Ronald T Ackermann  5 , Mohammed K Ali  6 , Stephen R Benoit  2 , Giuseppina Imperatore  2 , Christopher S Holliday  2 , Kai McKeever Bullard  2
Affiliations

Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity

Matthew J O'Brien et al. Am J Prev Med. 2023 Jun.

Abstract

Introduction: In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended prediabetes and diabetes screening for asymptomatic adults aged 35-70 years with overweight/obesity, lowering the age from 40 years in its 2015 recommendation. The USPSTF suggested considering earlier screening in racial and ethnic groups with high diabetes risk at younger ages or lower BMI. This study examined the clinical performance of these USPSTF screening recommendations as well as alternative age and BMI cutoffs in the U.S. adult population overall, and separately by race and ethnicity.

Methods: Nationally representative data were collected from 3,243 nonpregnant adults without diagnosed diabetes in January 2017-March 2020 and analyzed from 2021 to 2022. Screening eligibility was based on age and measured BMI. Collectively, prediabetes and undiagnosed diabetes were defined by fasting plasma glucose ≥100 mg/dL or hemoglobin A1c ≥5.7%. The sensitivity, specificity, and predictive values of alternate screening criteria were examined overall, and by race and ethnicity.

Results: The 2021 criteria exhibited marginally higher sensitivity (58.6%, 95% CI=55.5, 61.6 vs 52.9%, 95% CI=49.7, 56.0) and lower specificity (69.3%, 95% CI=65.7, 72.2 vs 76.4%, 95% CI=73.3, 79.2) than the 2015 criteria overall, and within each racial and ethnic group. Screening at lower age and BMI thresholds resulted in even greater sensitivity and lower specificity, especially among Hispanic, non-Hispanic Black, and Asian adults. Screening all adults aged 35-70 years regardless of BMI yielded the most equitable performance across all racial and ethnic groups.

Conclusions: The 2021 USPSTF screening criteria will identify more adults with prediabetes and diabetes in all racial and ethnic groups than the 2015 criteria. Screening all adults aged 35-70 years exhibited even higher sensitivity and performed most similarly by race and ethnicity, which may further improve early detection of prediabetes and diabetes in diverse populations.

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Conflict of interest statement

Dr. Bailey has received consultant fees from Lundbeck, Luto, Pfizer, and Sanofi. Dr. Bailey has received research support from Eli Lilly, Gordon and Betty Moore Foundation, Lundbeck, Merk, Pfizer, and Retirement Research Foundation for Aging. Dr. Ackerman has received consultant fees from UnitedHealth Group. Dr. Ali has received advisory panel support from Bayer AG and research support from Merk. All potential financial conflicts of interest reported here were unrelated to the current study. The other authors have no financial disclosures.

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