High-Risk Diabetes Patients Falling Through the Cracks

The United States Preventive Service Task Force’s (USPSTF) 2015 diabetes screening guidelines missed 55% of high-risk individuals with prediabetes or diabetes, a recent study published in PLOS Medicine found.

USPSTF guidelines recommend that patients between 40- and 70-years-old who are overweight or obese be screened for diabetes. However, the new study found that many patients who fell outside the age and weight ranges develop diabetes, especially ethnic and racial minorities.

Failing to identify individuals with dysglycemia in these high-risk groups inhibit these patients from taking preventive measures, such as exercising, eating right, or taking medications.

“Preventing and treating diabetes early is very important, especially in this setting of community health centers, were many of their socioeconomically disadvantages patients face barriers to following up regularly,” said senior study author Matthew O’Brien. “If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes.”

Under a provision in the Affordable Care Act, all services that are recommended by the USPSTF are required to be fully covered by insurers; however, patients who fall outside the diabetes screening guidelines and receive a test may end up having to pay out-of-pocket.

For the study, researchers examined electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013. The results of the study showed that among white patients who developed dysglycemia, 54% fell within the screening guidelines, compared with only 50% of African-Americans and 47% of Latino patients.

“Say I’m caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy,” O’Brien said. “She shouldn’t be screened, according to the guidelines, but she’s very likely to have either prediabetes or diabetes.”

Study authors noted that the USPSTF was on the right track with their guidelines, because they primarily focus on the 2 risk factors, age and weight, which are the most predictive of dysglycemia. However, physicians should still be aware of the findings so they can better understand which patients may be missed by the USPSTF’s criteria, and decide whether they want to move forward with screening those patients.

“We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites,” O’Brien said.

The next step for researchers is to determine what other factors should be taken into account when deciding who is at risk for diabetes, and to use electronic health records that will automatically prompt providers to screen patients with those risk factors.