By Natalie Elleson, MPH and Angela Forfia, MA
As you read these words, 1 in 3 American adults have prediabetes. That’s 88 million people across the country. However, only 15.3% of adults with prediabetes reported being told by a healthcare professional that they were in this high-risk state for the development of type 2 diabetes. Without screening, and discussions with their healthcare providers, most people with prediabetes remain in the lowest level of awareness. They are unaware of prediabetes, unaware that they are at risk, and unaware that there are effective preventive interventions, like the CDC lifestyle change program, that can help them prevent or delay type 2 diabetes.
That’s why in their update to the 2015 recommendation statement, the U.S. Preventive Services Task Force (USPSTF) conducted a systematic review on screening for prediabetes and type 2 diabetes. The review focused on the advantages and disadvantages of screening for abnormal blood glucose and interventions for prediabetes detected by these screenings. During their open comment period, USPSTF reviewed feedback and recommendations from national organizations, associations, and coalitions, such as The Diabetes Advocacy Alliance (DAA).
Kate Thomas, MA, ADCES Chief Advocacy and External Affairs Officer and DAA Co-Chair, played a role in providing recommendations in support of the new USPSTF diabetes screening. ADCES strongly supports the final recommendation, released August 24, 2021, stating “The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions.”
The organizations that comprise the DAA, including ADCES, share a common goal of elevating diabetes on the national agenda. Since 2012, ADCES has been working to support health centers across the country to implement the National Diabetes Prevention Program (National DPP) through two cooperative agreements from the Centers for Disease Control and Prevention (CDC) – DP12-1212 and DP17-1705. Through these efforts we have activated close to 70 CDC-recognized Diabetes Prevention Programs (DPP) across 22 states to provide lifestyle change programs to thousands of people with prediabetes in their local communities.
Through this work, we learned firsthand that screening matters. It raises awareness of prediabetes as well as awareness of evidence-based interventions, like the lifestyle change program. Providers are more likely to screen, and to initiate person-centered conversations about healthy eating, being active, monitoring, and setting weight goals when they know there are accessible, affordable, and effective community programs available to support their patients. Although provider referrals are not required, they do lead to greater enrollment, engagement, and retention, and greater engagement helps participants achieve weight goals, physical activity goals, and reductions in their A1C
Based on the 20 CDC-recognized Diabetes Prevention Programs ADCES is currently supporting under the 1705 cooperative agreement, 1743 (or 81%) of participants between the ages of 35 and 70 have enrolled, and 62% have enrolled based on a blood-based screening indicating prediabetes or a history of gestational diabetes mellitus (GDM). Screening has been especially effective in identifying Hispanic/Latinos, African Americans, and males who are often underdiagnosed with prediabetes, and connecting them to lifestyle change programs. Given the USPSTF’s final recommendation statement, we look forward to encouraging more of our health centers to adopt this approach to screening. If we can encourage each of our 20 health centers to screen 250 people between the ages of 35-70 who have overweight or obesity, they could potentially identify more than 1,600 people who would benefit from a CDC-recognized lifestyle change program.
Based on these guidelines, how many people can you identify for your own diabetes prevention or diabetes self-management education and support program? Find out how this evidence-based guideline can support your own system’s screening, awareness building, and referral efforts to diabetes prevention and DSMES. For more on type 2 diabetes prevention, visit DiabetesEducator.org/Prevention.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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