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According to an American study, extending screening for prediabetes and type 2 diabetes to all people over the age of 35 would have a greater impact in the fight against diabetes. The opinion of Dr Réginald Allouche, general practitioner and author of numerous books on the prevention of this disease.
Nearly half of American adults have type 2 diabetes or prediabetes, according to the Centers for Disease Control and Prevention (CDC). Worse: more than 80% of adults with prediabetes do not know they have this disease. This is the state of affairs in the United States which rightly worries the health authorities. Added to this, the disparities linked to the different social and ethnic categories are as many lost chances, according to the researchers.
Generalized screening based on age rather than BMI or origin, would be a more effective prevention according to a study by Northwestern University Feinberg School of Medicine, published in the American Journal of Preventive MedicineMarch 24.
Prediabetes doesn’t just affect overweight people
A person with prediabetes means that their blood glucose (sugar) level is higher than normal, but not high enough to be diagnosed with type 2 diabetes. Under these conditions, people with the condition have a higher risk developing type 2 diabetes, heart disease and/or stroke. They are also at risk for vision loss and kidney disease, especially when their blood sugar is not controlled.
In the United States, prediabetes strikes the population unevenly: diabetes rates are higher among black, Hispanic and Asian groups, compared to non-Hispanic whites, but screening, by a simple blood test, is also unequal.
In 2021, the United States Preventive Services Task Force (USPSTF) already recommended screening for prediabetes and type 2 diabetes for adults aged 35 to 70 who are overweight or obese (compared to a age limit of 40 years previously) because being overweight is one of the risk factors for prediabetes and type 2 diabetes.
However, the latest studies tend to show that screening people who are overweight or obese misses people of normal weight with prediabetes or diabetes: research shows that on average, blacks, Hispanics and Asians develop a diabetes with a lower body mass index (BMI). The measure is therefore not sufficient.
Lower age for more comprehensive prevention
Researchers in this new study looked at data from the National Health and Nutrition Examination Surveys (NHANES), a nationally representative sample of American adults. They used this data to compare the number of prediabetes and diabetes cases that would be identified in different screening scenarios, including their impact on certain racial and ethnic groups.
The researchers found that lowering the age for screening from 40 to 35 — as the United States Preventive Services Task Force (USPSTF) did with its 2021 recommendation — identified 13, 9 million more adults with prediabetes or diabetes. The largest screening gains due to this change occurred among Hispanics. Similarly, if all adults between the ages of 35 and 70 were screened, regardless of their BMI, it would identify even more people with prediabetes or diabetes.
“According to the study, this approach had a positive impact on all racial and ethnic groups. Age-only screening is also easier for physicians to implement because they don’t have to remember separate screening thresholds and BMI for different groups. It could help increase testing rates”, said Dr. Matthew O’Brien first author of this study.
Wider screening could therefore help catch more cases earlier, when they are easier to treat. By the time diabetes is diagnosed, a lot of damage has been done. On the contrary, by screening a person in the prediabetes stage, it is still possible to modify diet, exercise more, or improve sleep with a good hope of avoiding type 2 diabetes.
“Prediabetes is the only stage that is still reversible”
In France too, diabetes is a scourge: prediabetes probably affects 1.5 million people, 80% of whom will develop into type 2 diabetes without adequate treatment. In this race, Dr Réginald Allouche, general practitioner and author of numerous books on the prevention of diabetes, also pleads for early detection:
“Prediabetes is an important moment because it is the only stage that is still reversible. So I am in favor of screening for prediabetes and treating them, especially since the rules for avoiding diabetes are based on lifestyle and exercise measures, accessible measures”.
The doctor indicates a good second reason for this screening: when the hygiene and dietary measures are not enough, we must not leave it lying around. “Studies show that at the stage of prediabetes, we already have microangiopathies. Treatment should be undertaken“underlines the expert.
As for the gossips who think that this is another way to sell more drugs and to consolidate the laboratories, the doctor retorts that prevention is much more important: “This is a fallacious argument because the first drug for anyone in the pre-diabetes stage is metformin, which costs nothing, around 2 euros for 30 tablets. Detecting prediabetes above all makes it possible to avoid, if possible, diabetes.