We need to start screening overweight patients for Type 2 diabetes as early as age 35, according to an expert panel.
The new recommendation was made by the United States Preventive Services Task Force, “an independent panel of experts in primary care and prevention” convened regularly by the U.S. Department of Health and Human Services. Currently, doctors are not advised to screen overweight patients for Type 2 diabetes (T2D) until age 40.
Diabetes rates continue to grow in the United States and throughout the world, and experts are especially concerned by how prevalent the condition has become among younger adults and even adolescents. Dr. Chien-Wen Tseng, a task force member contacted by NBC News, said that “Our main reason for dropping the age is to match the screening with where the problem is: If diabetes and prediabetes are occurring at a younger age, then we should be screening at a younger age.”
If the recommendations are adopted, it is possible that millions of adults with Type 2 diabetes and prediabetes will be newly identified in the coming years, adults that perhaps would not have been diagnosed until later in life.
“Healthcare providers can help people improve their health by screening those who are overweight or obese for prediabetes and diabetes,” said task force member Dr. Michael Barry in a press release. “Screening and earlier detection can help prevent prediabetes and diabetes from getting worse and leading to other health problems.”
The task force strongly recommended lifestyle changes, “such as adjustments to diet and physical activity,” as the first changes to make for adults newly diagnosed with prediabetes or Type 2 diabetes. The panel also called metformin, typically the first drug prescribed to patients with T2D, as “effective” but that it has “fewer overall health benefits than lifestyle changes.”
For those who already do have undiagnosed Type 2 diabetes, the early warning could provide major benefits. Prompt interventions for newly-diagnosed diabetes were found to reduce diabetes-related and all-cause mortality. Doctors are also encouraged to apply even earlier screening to patients who may be especially likely to develop diabetes: those with a family history or those who belong to ethnicities that have a higher prevalence of the condition. The complications of diabetes can largely be prevented, but an unfortunately large number of people do not learn that they have diabetes until they have already done a great deal of damage to their bodies.
While there is some doubt about the severity of the condition that the American Diabetes Association calls “prediabetes,” there is little question that the condition is more concerning when found in younger patients than in older ones. People with prediabetes at middle-age have a “substantially increased risk” of developing diabetes within the next five years. It might be even worse for younger adults; T2D is known to be especially aggressive in younger patients. And the younger the patient, the more time he or she has to develop (and suffer from) the debilitating long-term consequences of diabetes, which can occur even when the condition is comparatively well-controlled.
There would seem to be little downside to encouraging lifestyle improvements at age 35 instead of age 40. The panel found “convincing evidence” that interventions for patients with prediabetes can reduce the progression to Type 2 and improve cardiovascular risk factors.