Diabetes Mellitus: Screening And Diagnosis
Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>
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Prediabetes Screening, Referral Can Help You Succeed In Mips
Prediabetes screening, referral can help you succeed in MIPS Medicare offers new ways for your practice to potentially benefit financially from the work you do to help at-risk patients prevent the onset of type 2 diabetes. Two AMA-suggested population-health Improvement Activities (IAs)glycemic screening services and glycemic referring serviceshave been added to available options for physicians participating in the Medicare Quality Payment Programs Merit-based Incentive Payment System (MIPS). This story is part of the AMAs Navigating the Payment Process topic hub. Explore other Medical Topics That Matter . Physicians will not get direct Medicare payment for the screening and referring services, but they will count as IAs, which will count toward their final MIPS score and will Medicare reimbursement rates in 2020. Physicians can choose to participate in one or both of these IAs. To get IA credit, physicians will need to attest they have implemented systematic screening of at-risk Medicare beneficiaries for abnormal blood glucose levels for 60 percent of the patients in their electronic health records for at least 90 consecutive days within the 2018 reporting period. For patients found to have prediabetes, physicians have to attest that they referred 60 percent of their patients to a diabetes prevention program recognized by the Centers for Disease Control and Prevention (CDC) operating under the framework of the National Diabetes Prevention Program for at least 90 consecutive days within the 2018 reporting period. The 60 percent threshold for both of these IAs will rise to 75 percent in 2019. For this clinic, diabetes prevention program is in the house Prevent Diabetes STAT , hosts a wealth of diabetes-prevention tools and resourcesincluding a toolkit that details how Continue reading >>
Screening For Prediabetes And Type 2 Diabetes Mellitus
Screening for Prediabetes and Type 2 Diabetes Mellitus 1University of Chicago, Chicago, Illinois Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. JAMA. 2016;315(7):697-698. doi:10.1001/jama.2015.17545 Abnormal blood glucose and type 2 diabetes are prevalent conditions in the United States; about 115 million adults have prediabetes or diabetes. 1 Prediabetes is defined as IFG, IGT, or an increased average blood glucose level indicated by an increased hemoglobin A1c level. The incidence of type 2 diabetes among patients with prediabetes may be as high as 35.5 to 70.4 new diagnoses per 1000 person-years. 2 In 2014, type 2 diabetes affected 9.3% of US adults aged 20 years or older, and 36.4% of adults with type 2 diabetes were undiagnosed. 1 Because early-stage type 2 diabetes is often asymptomatic, diagnosis can be delayed commonly from 4 to 8 years. 3 Abnormal blood glucose and type 2 diabetes can be screened for by well-established tests. Type 2 diabetes significantly increases the risk of several comorbid conditions; eg, kidney failure, nontraumatic lower limb amputations, blindness, heart disease, stroke, peripheral vascular disease, dementia, and depression. Treatments to maintain euglycemia include lifestyle changes, medication therapies, and surgery. Continue reading >>
Diabetes And Prediabetes: Screening Guidelines And The Expansion Of The National Diabetes Prevention Program In Los Angeles County
Diabetes and Prediabetes: Screening Guidelines and the Expansion of the National Diabetes Prevention Program in Los Angeles County Diabetes is a major cause of morbidity and mortality and an important contributor to the rising health care costs in the United States. In Los AngelesCounty, an analysis of local National Health and Nutrition Examination Survey (NHANES) data indicates that approximately 10% of LA County adults 20 years of age and older have been diagnosed with diabetes and an additional 4% remains undiagnosed. 1 In addition, the local NHANES analysis shows that approximately 40% of the countys adult population has prediabetes. The Centers for Disease Control and Prevention (CDC) estimate that 90% of persons with prediabetes are undiagnosed, 2 underscoring the significant need for improved screening and linkage to effective strategies for preventing diabetes or its complications. This article summarizes the recommended screening guidelines for type 2 diabetes and prediabetes and provides information on the National Diabetes Prevention Program, an evidence-based prevention intervention for those with prediabetes. The article also highlights the importance of creating healthier environments where improved nutrition and increased physical activity are the easy choices for patients and the community. The U.S. Preventive Services Task Force (USPSTF) recommends that adults 40 to 70 years of age who are overweight or obese, as defined by a body mass index (BMI) of >25.0, should be screened for abnormal blood glucose every three years. 3 The USPSTF recommends screening at younger ages or at lower BMI in adults at increased risk for diabetes (see box below).For example, evidence suggests that Asians may have an increased risk of type 2 diabetes at lower BMIs and shou Continue reading >>
Prediabetes: Can An Online Screening Test Really Work?
Analyst: F. Perry Wilson, MD, MSCE An online test sponsored by the American Medical Association and the CDC among others, aims to evaluate an individual's risk of pre-diabetes. But a research letter appearing in JAMA Internal Medicine suggests that this tool would classify the majority of Americans as "high-risk." In this 150-second analysis, MedPage Today clinical reviewer F. Perry Wilson discusses the merits (or lack thereof) of online screening for pre-diabetes. A transcript of his commentary follows: Today, I'm talking about your risk of your risk of developing a disease. You heard that right. It turns out that there is an online test, sponsored by these fine folks: that will tell you if you are at high-risk of having pre-diabetes, which is, of course, a major risk factor for type 2 diabetes. Briefly, pre-diabetes is a state where your blood sugar is elevated, but not quite high enough to diagnose diabetes: There is debate in the medical community about the over-medicalization of lab values that may fall within a normal range for some people, but the development of an online risk-tool, not for diabetes, but for pre-diabetes, seems to put the stamp of the diabetes establishment firmly in the "pre-diabetes is a real disease" camp. Personally, I'm a bit sick of the "pre" diagnoses. Pre-cancer. Pre-hypertension. No one is ever diagnosed with pre-cholera. But, fine, as a public health issue, maybe motivating people with a bit of scary sounding medical-ese is ok. When you visit doihaveprediabetes.org, you are presented with this friendly screen: According to a research letter in the Journal of the American Medical Association, if you all were to go take this risk survey, 3 out of 5 of you would be deemed high risk. And if you're over age 60, make that 4 out of 5. This tra Continue reading >>
Prediabetes: To Screen Or Not To Screen?
In this day and age, personalized medical technology makes it easier than ever to learn about our own health and how our body is doing without needing to see a doctor. From wearable fitness trackers to shopping metrics that can predict when you’re pregnant, smart tech and big data are working together to teach us more about ourselves than we ever knew before. And while it’s cool to know how many more kilometers we have to walk before our next “Pokémon Go” egg hatches, it’s also useful to directly apply this information to improving health outcomes on a national level. That philosophy is at the center of a debate over the effectiveness of screening tests to assess people’s risk of prediabetes. And that debate was revived this week with a published study that estimated that almost 60 percent of people in the United States over the age of 40 are at high risk for developing prediabetes. Read more: Five signs of aging that could be diabetes in disguise » Are you at risk? The Centers for Disease Control and Prevention (CDC), American Diabetes Association (ADA), and the American Medical Association (AMA) teamed up to produce a free online screening test to predict whether someone might be at higher risk for prediabetes based on seven questions. The online test examines age (1 to 3 points), sex (1 point), gestational diabetes (1 point), family history (1 point), blood pressure (1 point), physical activity (1 point), and weight (1 to 3 points). A score of 5 or higher is considered to be high risk. The website recommends that people at high risk see their doctor and ask to get a blood test for prediabetes. Prediabetes, currently defined by the ADA to be a fasting blood sugar level of 100 milligrams per deciliter, occurs when someone has a blood sugar level that is h Continue reading >>
Prediabetes, Diabetes Screening Criteria Miss Half Of Patients
Prediabetes, Diabetes Screening Criteria Miss Half of Patients Current diabetes screening criteria that use age and weight alone, as recommended by the US Preventive Services Task Force (USPSTF), may miss up to half of prediabetes and diabetes cases, according to a study published online April 12 in the Journal of General Internal Medicine. Using expanded criteria on the basis of other high-risk factors (gestational diabetes, polycystic ovarian syndrome, racial/ethnic minority, and/or family history of diabetes) may improve detection of abnormal blood glucose levels. The study is the first nationally representative evaluation of how using expanded screening criteria could improve diabetes detection. "This seems like a no-brainer to screen patients who have any of these additional risk factors," first author Matthew O'Brien, MD, assistant professor of medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois, said in a press release. "By demonstrating how well these expanded criteria work in identifying patients with prediabetes and diabetes, we're proposing a better path for the USPSTF to strengthen its screening guidelines." The USPSTF 2015 recommendations call for prediabetes and diabetes screening in adults aged 40 to 70 years who are overweight or obese (referred to as limited criteria). The USPSTF also suggests, but does not formerly recommend, earlier screening in people with certain diabetes risk factors, including a history of gestational diabetes, polycystic ovarian syndrome, membership of an ethnic/racial minority, or a family history of diabetes (expanded criteria). Early screening is important because it can enable earlier pharmacotherapy and lifestyle modification, potentially warding off more serious complications of diabetes. "Th Continue reading >>
Diabetes/pre-diabetes Screening For Patients With Dsp
Diabetes/Pre-diabetes screening for patients with DSP Diabetes/Pre-diabetes screening for patients with DSP Measure Purpose: Improve care through early intervention and control of diabetes in DSP patients The numerator: Patients who had screening tests for diabetes (eg, fasting blood sugar test, hemoglobin A1C, or a 2-hour Glucose Tolerance Test) reviewed, requested, or ordered when seen for an initial evaluation for distal symmetric polyneuropathy The denominator: All patients age 18 years and older with a diagnosis of distal symmetric polyneuropathy Exceptions are removed from the denominator for: Patient has a known medical condition to cause neuropathy Patient does not have insurance to pay for testing Examples of key phrases you could use to meet the measure: Fasting blood sugar test(results reviewed, or requested, or ordered) Hemoglobin A1c(results reviewed, or requested, or ordered) 2-hour glucose tolerance test (results reviewed, or requested, or ordered) Dr. Gagnon had 43 patients over the age of 18 seen for an initial evaluation for distal symmetric polyneuropathy from January 1 through December 31. This is the denominator. Three patients had a diagnosis of diabetes and one declined to undergo testing. These four patients are removed from the denominator. Of the remaining 39 patients, 21 had screening for diabetes reviewed and three had a screening for diabetes ordered when they were seen for their initial evaluation of DSP. This is the numerator. Quality of care = (21+3)/(43-4). Dr. Gagnon has a score of 61% for this measure. Continue reading >>
Hypertension And Prediabetes Screening Project
WVDHHR > Division of Health Promotion and Chronic Disease Hypertension and Prediabetes Screening Project The Division of Health Promotion and Chronic Disease has a special focus on preventing heart disease and type 2 diabetes--two of West Virginia's leading causes of death.HPCD's Health SystemsBranchworks with localhealth departments in West Virginia to raise awareness of prediabetes and high blood pressure through screening and education. HPCD initiatedtheHypertension-Prediabetes Screening pilot project withRandolph,Grant and Mineral County Health Departments.Staff atthose health departmentsused these tools to screen patients: The goal of this project is to educate and raise awareness of prediabetes and hypertension in patients, establish a screening algorithm for health departments and to create a local health department prediabetes-hypertension awareness model. Screening refers to the application of a medical procedure or test to people who as yet have no symptoms of a particular disease, for the purpose of determining their likelihood of having the disease The screening procedure itself does not diagnose the illness Those who have a positive result from the screening test will need further evaluation with subsequent diagnostic tests or procedures Overall goal: Reduce morbidity or mortality from the disease by detecting diseases in their earliest stages, when treatment is usually more successful Suitable screening criteria includes low cost, ease of administration, safe, imposes minimal discomfort upon administration, and is acceptable to both patients and practitioners Continue reading >>
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Recommendations For Community-based Screening For Prediabetes And Diabetes
AADE White Paper The high prevalence of prediabetes and diabetes represents a major health problem in the United States (U.S.). According to the Centers for Disease Control and Prevention (CDC), in 2012 persons with diabetes in the U.S. accounted for 9.3% of the nation’s population or 29.1 million people. Of those affected, only 21.0 million people were diagnosed with diabetes; thus, 8.1 million individuals (27.8%) were undiagnosed.1 In addition, the 2012 CDC statistics for the US population estimated that there were 86 million adults with prediabetes.1 Clearly, an unacceptably high percentage of persons with or at risk for diabetes in the U.S. are undiagnosed and, as a result, not receiving proper care to avoid or manage diabetes and its complications. Groups within the population who are at higher risk include individuals over 45 years of age, racial and ethnic minorities, women who have had gestational diabetes but do not receive adequate follow-up testing postpartum, and those without access to medical care, such as the uninsured.1,2,3 Given that our current prevalence of diabetes (9.3%) is nearly triple that of 1990 (3.6%), there is almost universal agreement that we must take effective steps to reduce the growth of this epidemic. Among such steps, there is strong support for earlier diagnosis and intervention to minimize the progression of diabetes and the development of associated complications.4-6 In response to the diabetes epidemic, many diabetes stakeholder groups and organizations in the U.S., especially at the local level, advocate for community-based screening (CBS) in venues such as health fairs or diabetes awareness events. Thousands of individuals throughout the nation have been and continue to be screened at such events in the hope that those wh Continue reading >>
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Accuracy Of Prediabetes Screening Tests Is Low
Accuracy of prediabetes screening tests is low Accuracy of prediabetes screening tests is low The accuracy of the tests used to detect prediabetes in screening programs is low. The diagnostic accuracy of the current tests used to detect prediabetes in screening programs is low, according to a study published in BMJ. The results showed that the fasting glucose screening test is specific but not sensitive, and the HbA1c test is neither sensitive nor specific. Eleanor Barry, MBBS, BSc, MRCP, MRCGP, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and colleagues assessed the diagnostic accuracy of screening tests for prediabetes and the efficacy of lifestyle or metformin interventions in preventing the onset of type 2 diabetes. The researchers performed one meta-analysis to summarize the accuracy of screening tests for identification of prediabetes, with the oral glucose tolerance test as the standard, and they conducted an additional meta-analysis that assessed relative risk of progression to type 2 diabetes after lifestyle intervention or treatment with metformin. The investigators included 49 studies of screening tests and 50 intervention trials in their final analysis. They examined empirical studies examining the accuracy of tests for the identification of prediabetes, randomized trials, and interventional studies. As the prevalence of type 2 diabetes rises inexorably in high, middle, and low income countries alike, controversy continues to surround the questions of who is at risk' and what preventive interventions to offer them, the study authors wrote. A screen and treat policy will be effective only if a test exists that correctly identifies those at high risk (sensitivity) while also excluding those at low risk (specificity Continue reading >>
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Prediabetes Screening: How And Why
Screening involves the testing of asymptomatic, high-risk individuals to assess whether they meet the criteria for either prediabetes or type 2 diabetes. Screening recommendations have been made by different groups, including the American Diabetes Association and the United States Preventive Services Task Force . Although these recommendations sometimes advise screening for slightly different groups of individuals, all of them advise the use of one or more blood tests to determine the degree of blood glucose elevation. Screening for prediabetes and diabetes is more frequently done in health care settings than community settings. The process used to target and test patients may include a team approach, employing various health care professionals such as medical assistants, nurses, physicians, diabetes educators, or others. Electronic health records can alert health care team members about patients who should be targeted for diabetes screening, either during or between visits to the clinic. Health care providers in a variety of practice settings can consider use of standard ordering protocols for glucose testing, which may be approved by physicians up front but carried out by other team members when at-risk patients are identified. In addition, provider teams can look for opportunities to screen for prediabetes while managing a patients other conditions. For example, when screening for hyperlipidemia, a fasting glucose may easily be added to a standard fasting lipid test panel. Continue reading >>
Screening And Monitoring Of Prediabetes
Screening for Prediabetes AACE recommends that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or type 2 diabetes (T2D) (1). Age ≥45 years without other risk factors CVD or family history of T2D Overweight or obese Sedentary lifestyle Member of an at-risk racial or ethnic group: Asian African American Hispanic Native American (Alaska Natives and American Indians) Pacific Islander High-density lipoprotein cholesterol (HDL-C) <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and/or metabolic syndrome Polycystic ovary syndrome (PCOS), acanthosis nigricans, or nonalcoholic fatty liver disease (NAFLD) Hypertension (blood pressure >140/90 mm Hg or on antihypertensive therapy) History of gestational diabetes or delivery of a baby weighing more than 4 kg (9 lb) Antipsychotic therapy for schizophrenia and/or severe bipolar disease Chronic glucocorticoid exposure Sleep disorders in the presence of glucose intolerance (A1C >5.7%, IGT, or IFG on previous testing), including obstructive sleep apnea (OSA), chronic sleep deprivation, and night-shift occupation In the event of normal results, repeat testing at least every 3 years. Clinicians may consider annual screening for patients with 2 or more risk factors (1). Medications and Prediabetes Risk Specific medications that increase prediabetes risk include: Antidepressants: The ongoing use of antidepressant medications may modestly increase the risk of developing prediabetes or T2D, although the elevation in absolute risk is modest (2). Psychotropic agents: Certain treatments for schizophrenia or bipolar disease may increase prediabetes, T2D, and/or CVD risk. Substantial weight gain has b Continue reading >>
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Pre-diabetes Screening Can Improve Health Outcomes
Pre-Diabetes Screening Can Improve Health Outcomes Borderline diabetes is a term historically used to describe blood sugars that are elevated, but not yet high enough to confirm a diagnosis of diabetes. The term was not clearly defined and no specific treatment was recommended, so people often were not sure how to manage their condition. In recent years, terminology has changed from borderline to pre-diabetes, which has clearly defined lab values and established treatment recommendations. Screening for pre-diabetes can help identify those at high risk of diabetes so that recommendations can be made to prevent or delay progression to type 2 diabetes. American Diabetes Association (ADA) estimates that 1 in 3 adults have pre-diabetes. Many are not aware of this condition because it has no obvious symptoms. Risk factors for diabetes include family history, obesity, sedentary lifestyle, and presence of health problems such as high blood pressure, high cholesterol, or history of gestational diabetes. Without identification and treatment, pre-diabetes will often progress to type 2 diabetes within 5 years. The 7 question Pre-Diabetes Risk Test can be taken online at www.diabetes.org , the official website of the American Diabetes Association. After the test, you get an immediate risk score and discussion of your risk factors, which you can print and take to your healthcare provider. Providers can discuss your risk status, order lab screening tests, and make recommendations for management of pre-diabetes. Lab tests offered for screening may include an A1C test, fasting blood sugar test, or glucose tolerance test. Each of these tests have different purposes in making a diagnosis. The A1C test estimates blood sugar levels over 2-3 months, while a fasting blood sugar test measures Continue reading >>
Acpm Awards Grants To Improve Prediabetes Screening, Referral
ACPM awards grants to improve prediabetes screening, referral December 14, 2017 | Daniel Allar | Practice Management Six healthcare organizations have been awarded grants from the American College of Preventive Medicine (ACPM) to develop models to improve prediabetes awareness, screening and referral to diabetes prevention programs, the ACPM announced Dec. 14. The referral models will be designed specifically for Medicare patients because the Medicare Diabetes Prevention Program is scheduled to become a covered benefit starting April 1, 2018, according the ACPMs press release . There is tremendous value in the National DPP for preventing one of our nations most prevalent and growing conditions, ACPM President Robert Carr said in the release. We need to increase the number of patients who are referred by their physicians to the CDC-recognized diabetes prevention programs. We are excited about the innovative ideas and models that the grantees will develop to amplify and accelerate uptake in this important effort. The six healthcare organizations, representing three provider categories, are as follows: South Nassau Community Hospital, Oceanside, New York (integrated delivery system) Portland Family Medical Center, Portland, Maine (integrated delivery system) Griffin Faculty Physicians, Derby, Connecticut (independent practice association) Accent on Health, Washington, D.C. (independent practice association) Northeast Missouri Health, Kirksville, Missouri (federally qualified health center) Christopher Rural Health Planning Corporation, Mulkeytown, Illinois (federally qualified health center) Each grantee will develop and document methods for increasing prediabetes awareness, screening and referral within medical practice settings, resulting in case studies and suggestions Continue reading >>
