Structured Abstract

Contents

• 1. Introduction
  • Purpose
  • Previous USPSTF Recommendation
  • Condition Definition
  • Prevalence and Burden of Disease
  • Etiology and Natural History
  • Risk Factors
  • Rationale for Screening and Screening Strategies
  • Interventions and Treatment
  • Current Clinical Practice
  • Recommendations of Other Groups
• 2. Methods
  • Key Questions and Analytic Framework
  • Search Strategies
  • Study Selection
  • Data Abstraction and Quality Rating
  • Data Synthesis
  • External Review
  • Response to Public Comment
• 3. Results
  • Contextual Question 1 What Is the Yield (Incidence) of Starting Screening at Different Ages or Rescreening at Different Intervals in Adults With an Initial Normal Fasting Blood Glucose, HbA1c, or Glucose Tolerance Test?
  • Contextual Question 2 What Is the Utility of Using Formal Risk Calculators Versus Risk Factor Assessment (e.g., Family History, Body Mass Index) in Determining a Person's Risk for Developing Diabetes?
  • Contextual Question 3 What Is the Utility of Existing Modeling Studies of Type 2 Diabetes Screening Versus No Screening in Examining Important Health Outcomes?
  • Contextual Question 4 Is There Evidence That Intensive Blood Pressure or Lipid Lowering or Use of Aspirin Is More Effective in Persons With Diabetes Compared With Persons Without Diabetes?
  • Key Question 1 Is There Direct Evidence That Screening (Either Targeted or Universal) for Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance in Asymptomatic Adults Improves Health Outcomes?
  • Key Question 2 What Are the Harms of Screening Adults for Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance?
  • Key Question 3 Do Interventions for Screen-Detected or Early Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance Provide an Incremental Benefit in Health Outcomes Compared With No Interventions or Initiating Interventions After Clinical Diagnosis?
  • Key Question 4 What Are the Harms of Interventions for Screen-Detected or Early Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance?
  • Key Question 5 Is There Evidence That More Intensive Glucose, Blood Pressure, or Lipid Control Interventions Improve Health Outcomes in Adults With Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance Compared With Traditional Control? Is There Evidence That Aspirin Use Improves Health Outcomes in These Populations Compared With Nonuse?
  • Key Question 6 What Are the Harms of More Intensive Interventions Compared With Traditional Control in Adults With Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance?
  • Key Question 7 Do Interventions for Impaired Fasting Glucose or Impaired Glucose Tolerance Delay or Prevent Progression to Type 2 Diabetes?
  • Key Question 8 Do the Effects of Screening or Interventions for Screen-Detected or Early Type 2 Diabetes, Impaired Fasting Glucose, or Impaired Glucose Tolerance Vary by Subgroups, Such as Age, Sex, or Race/Ethnicity?
• 4. Discussion
  • Summary of Review Findings
  • Limitations
  • Emerging Issues and Next Steps
  • Relevance for Priority Populations
  • Future Research
  • Conclusions
• References
• Appendix A Detailed Methods
• Appendix B Evidence and Quality Tables

Acknowledgments: The authors acknowledge AHRQ Medical Officer, Quyen Ngo-Metzger, MD, MPH, as well as current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations. The authors also acknowledge the Portland Veterans Affairs Medical Center for supporting the work of Hetal Patel, MD, Preventive Medicine Resident, on this report.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. HHSA 290-2007-10057-I, Task Order No. 13. Prepared by: Pacific Northwest Evidence-based Practice Center²

Suggested citation:

Selph S, Dana T, Bougatsos C, Blazina I, Patel H, Chou R. Screening for Abnormal Glucose and Type 2 Diabetes Mellitus: A Systematic Review to Update the 2008 U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 117. AHRQ Publication No. 13-05190-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10057-I, Task Order No. 13). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; www​.ohsu.edu/epc