Health Experts Recommend Diabetes Screenings at 35 as Obesity Climbs

A national body of health experts is recommending clinicians begin screening their patients for prediabetes and type 2 diabetes at age 35, five years earlier than currently suggested, now making nearly 40% of the adult population eligible for the free screening.

It is a significant recommendation by the U.S. Preventive Services Task Force as nearly one in seven Americans now has diabetes and 34.5% meet the criteria for prediabetes. High blood glucose is the leading cause of kidney failure and new cases of blindness among adults and is associated with an increased risk of cardiovascular disease, stroke, nonalcoholic liver disease and nonalcoholic steatohepatitis. It is also the seventh leading cause of death in the United States.

The final recommendation by the Task Force was published Aug. 24 in the journal JAMA.

“Diabetes continues to be an enormous public health problem in the United States,” said Stanford Health Policy Director Douglas K. Owens, a former chair of the Task Force and senior fellow at the Freeman Spogli Institute for International Studies. “Identifying people at risk for developing diabetes enables them to make lifestyle changes that can delay or prevent diabetes.”

The Task Force is an independent panel of national experts in prevention and evidence-based medicine whose recommendations are followed by primary care clinicians nationwide.

Being obese or overweight are the strongest risk factors for developing type 2 and prediabetes and more than 42% of Americans are now considered obese today — a jump of 10% in just the last decade. The recommendation is particularly important during the pandemic, as diabetes is one of the risk factors for becoming severely ill from COVID-19.

Children and adolescents are also seeing a high prevalence of type 1 and 2 diabetes, according to another study released on Aug. 24 in JAMA. Researchers examined 3.5 million children aged 19 and younger and found the prevalence for type 1 grew by 45% from 2001 to 2017. The increase for type 2 diabetes among children 10 to 19 years old went up to 95% over the same period.

If screening shows someone has prediabetes, effective and preventive interventions may prevent or delay the onset of diabetes, such as changes to the diet, an increase in exercise and medication.

“Fortunately, there are interventions that are effective for preventing prediabetes from progressing to diabetes and in helping people with prediabetes improve their health,” said Task Force vice chair Michael Barry.

An accompanying editorial in JAMA notes the USPSTF recommendation also highlights the increasing prevalence of diabetes in younger at-risk racial and ethnic groups. The authors highlighted a recent study using pooled National Health and Nutrition Examination Survey data from 2005 through 2016, which found that one-in-four young adults aged 19-34 had abnormal glucose metabolism — with even higher prevalence in Black and Hispanic/Latinx young adults.

“Lowering the age for screening may facilitate earlier recognition of diabetes, including in the racial and ethnic groups at highest risk,” they write. They added, however, that those racial and ethnic groups at highest risk have limited access to effective, costly treatments such as behavior-change support programs, bariatric surgery, and novel pharmacologic therapies.

So merely expanding the eligible population is not enough.

“Addressing the factors that contribute to unequal access to healthy foods and opportunities for physical activity is a much greater challenge and will require a higher public health priority and increased funding,” the co-authors of the editorial wrote.