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SCREENING FOR DIABETES - THE UNITED STATES PREVENTIVE SERVICES TASK FORCE WEIGHS IN - BUT THEY GET IT WRONG
(February 2004)

The United States is in the throes of two major epidemics, overweight and diabetes. Overweight is the major risk factor for adult onset diabetes. About 60 percent of adults are either overweight or frankly obese. There are about 17 million diabetics. Both epidemics have gotten progressively worse over the last two decades. Healthful Life recommends screening for diabetes with a fasting blood sugar because, if people are identified with a blood sugar that is elevated (110 to 125 milligrams per 100 ml), but not high enough to be called diabetic, most of them can avoid diabetes by weight loss and exercise.

The United States Preventive Services Task Force (USPSTF) is considered our premier unit in regard to policy and recommendations about health promotion and disease prevention. The Task Force has, for some reason, not made any recommendations about diabetes prevention for the last seven years. Finally, in the February 4, 2003 issue of the Annals of Internal Medicine, the Task Force took a stand - of sorts. They conclude “the evidence is insufficient for or against routinely screening asymptomatic adults for type 2 (adult onset) diabetes”.

Yet, here are other quotes from their analysis that make the conclusion very strange.

“Intensive programs of lifestyle modification (diet, exercise, and behavior change) should be considered for patients who have impaired fasting glucose since several large trials have demonstrated that those programs can significantly reduce the incidence (occurrence) of diabetes in these patients”.

“Five randomized clinical trials have reported results from lifestyle or drug interventions in people with impaired fasting glucose using progression to diabetes as the relevant outcome. Three of these trials (the largest ones with the most intensive interventions) found that intensive lifestyle interventions reduced the development of diabetes by 42 to 58 percent over three to six years”.

So, if we screen people with a fasting blood sugar, we can potentially prevent at least 42 to 58 percent of adult onset diabetes; other studies suggest the figure may be higher and that in the range of two-thirds of diabetes can be prevented.

Healthful Life will continue to urge doing a fasting blood sugar every two years at the comprehensive prevention examination. Our recommendations are similar to those of the American Heart Association. The American Diabetic Association starts screening at age 45, but at a younger age for persons who are overweight.

So, the Task Force is out of step and its non-stand is not consistent with the evidence it presents.

Our recommendation stands: Have your blood sugar determined every two years at the comprehensive prevention examination. If your blood sugar is on the high side and that finding is confirmed in a second test a few weeks (or months) later, you are at considerably increased risk of diabetes. To avoid that, the prescription for most people is a combination of weight loss and increased physical activity.