Diabetes: Screening, Diagnosis, and Prevention of Type 2 Diabetes

Ernestine Lee
FP Essentials 2021, 504: 16-21
From 2013-2016, 34.5% of US adults had prediabetes. The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults ages 40 to 70 years with overweight or obesity for abnormal blood glucose, and screening for gestational diabetes in pregnant women after 24 weeks. The American Diabetes Association (ADA) recommends screening all patients older than 45 years for prediabetes and diabetes, and screening earlier for patients with risk factors. Screening in younger patients is based on risk factors. The diagnostic criteria for prediabetes and diabetes require two abnormal test results from the same sample or from two separate samples, in the absence of unequivocal hyperglycemia or symptomatic hyperglycemia. Physical activity and healthy eating patterns continue to be the cornerstones of diabetes prevention. Although no drugs are approved by the Food and Drug Administration (FDA) for diabetes prevention, strong evidence supports the use of metformin in adults with prediabetes. In children, metformin use for the prevention of diabetes requires more study. Rates of progression from prediabetes to type 2 diabetes range from 5.8% to 18.3% per year, depending on the population studied.

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