April 12, 2021
National Center for Health Research’s Public Comments on the United States Preventive Services Task Force’s Draft Recommendation Regarding Screenings for Prediabetes and Type 2 Diabetes Mellitus
We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding the screening for prediabetes and Type 2 Diabetes Mellitus.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We agree with the USPSTF that diabetes is a serious public health concern, and that screening in asymptomatic adults can be an important tool to allow earlier detection and improve overall health outcomes.
That being said, USPSTF’s recommendation to lower the age for screening from 40 to 35 is not based on RCT data. USPSTF states that the justification for lowering the recommended age to 35 is based on a 2014 epidemiological study that indicates the number needed to screen (NNS) decreases dramatically at age 35. However, the authors of that study recommend universal screening for all adults 35 years and older because they did not study variations on NNS based on weight. While being overweight or obese is certainly a risk factor for diabetes, USPSTF has not provided data to support its recommendation to screen only asymptomatic overweight adults.
Additionally, while the draft recommendation highlights that there are several risk factors associated with developing prediabetes and type 2 diabetes in adults, the recommendation is only for asymptomatic overweight and obese adults of a certain age range. USPSTF does not provide sufficient justification for why weight is the only risk factor considered in the recommendation. Other risk factors such as family history or the fact that diabetes is more prevalent in some races compared to others has not been adequately addressed in this recommendation.
In summary, while we agree that diabetes screening is an important tool, the USPSTF recommendation appears to be not fully rooted in data. There seems to be no clinical evidence to support USPSTF’s recommendation of lowering the age for screening to 35, while at the same restricting to only those at risk due to weight and not considering other risk factors such as family history and race.