The Diabetes Epidemic: Urgent Need to Emphasize Prevention, Detection, Management of Type 2 Diabetes

Rates of prediabetes and type 2 diabetes, as well as obesity, continue to soar. The Centers for Disease Control and Prevention estimates that 34.5% of US adults have prediabetes and 10.5% of all Americans have diabetes, making it one of the most common chronic diseases in the United States. Of those individuals with diabetes, 21.4% remain undiagnosed.¹

The American Diabetes Association (ADA) indicates that it is critical for clinicians to screen patients for prediabetes and diabetes, especially those with risk factors for the disease. The ADA also stresses the importance of prevention, detection, and management of prediabetes and type 2 diabetes, as well as tailoring treatment based on patient need. Early diagnosis and clinical intervention are key to preventing and reducing the incidence of diabetes-related complications.

A new study in the American Journal of Preventative Medicine indicated that there are several “missed opportunities” for diabetes prevention in the United States. In the study, researchers examined the electronic health records of 21,448 patients within a large health center who met the US Preventive Services Task Force (USPSTF) criteria for prediabetes screening between August 1, 2019, and October 31, 2020.

The authors revealed that of the 21,448 patients identified as eligible for prediabetes screening, 13,465 (62.8%) were screened in accordance with the USPSTF recommendations. Of those patients screened, 3430 met the requirements for a prediabetes diagnosis. Only 185 (5.4%) of patients who screened positive for prediabetes received a formal diagnosis of prediabetes, and no patients who received a diagnosis received appropriate treatment for their prediabetes.

They also noted that women were more likely than men to be screened (P<.001). They concluded that although a majority of eligible patients receive appropriate screening for prediabetes, diagnosis and treatment of patients who screen positive for prediabetes is not common practice, and future research and policy may benefit from a focus on classifying diabetes prevention as a quality metric and encouraging behaviors consistent with diabetes prevention.²

In an interview, the lead author of the study, Arch G Mainous III, PhD, a professor in the department of health services research, management, and policy at the University of Florida, stated, “Although we have millions of people with prediabetes who are recommended to be screened and treated for diabetes prevention, in actual practice we are not doing a very good job of screening and treating them. Our goal should be to prevent diabetes, not just manage it after a patient develops it.”³

In an effort to guide and encourage clinicians toward screening for prediabetes and type 2 diabetes, in August 2021, the UPSTF issued screening recommendations. The latest recommendation statement from the organization, which was published in the Journal of the American Medical Association, lowers the recommended screening age from 40 to 35 years for type 2 diabetes. The recommended screening age for prediabetes and type 2 diabetes in asymptomatic adults with overweight or obesity is 35 to 70 years.

A member of the Task Force, Chien-Wen Tseng, MD, MPH, MSEE, stated, “Clinicians can prevent serious health complications by screening adults with overweight or obesity for prediabetes and diabetes. With appropriate screening, diabetes can be detected and treated earlier to improve overall health.”⁴

More information about the recommendations can be found at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes.

While the world is still battling the COVID-19 virus and its variants, it is still important to recognize, treat, and prevent other medical conditions. Undiagnosed and untreated diabetes is associated with multiple health complications, and as the incidence of diabetes continues to rise, it is imperative that clinicians—including pharmacists—expand patient education initiatives to augment awareness about the serious health consequences associated with diabetes, its risk factors, importance of screening, early diagnosis, and clinical intervention, and the most effective strategies to prevent and treat it.

Empowering patients with knowledge is the best defense in the battle against diabetes. The ADA indicates that small lifestyle changes such as diet, weight loss, and exercise, when appropriate, can be beneficial in reducing the risks associated with diabetes.

More information about these strategies can be found on the ADA website at https://www.diabetes.org/diabetes-risk/prevention.

References:

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html
2. Mainous AG 3rd, Rooks BJ, Wright RU, Sumfest JM, Carek PJ. Diabetes prevention in a US healthcare system: A portrait of missed opportunities. Am J Prev Med. 2021:S0749-3797(21)00414-1. doi:10.1016/j.amepre.2021.06.018.
3. ‘Diabetes epidemic will continue’ until focus shifts to prevention. Healio. November 24, 2021. https://www.healio.com/news/primary-care/20211124/diabetes-epidemic-will-continue-until-focus-shifts-to-prevention
4. Campbell P. USPSTF lowers recommended screening age for type 2 diabetes. Endocrinology Network. August 24, 2021. https://www.endocrinologynetwork.com/view/uspstf-lowers-recommended-screening-age-for-type-2-diabetes