Applying a widely endorsed risk assessment tool for prediabetes to the U.S. population suggests that 3 out of 5 people 40 years or older and 8 out of 10 people 60 or older are at high risk for prediabetes, according to a new research letter published online by JAMA Internal Medicine.
The U.S. Centers for Disease Control and Prevention, the American Diabetes Association and the American Medical Association have promoted a web-based risk test to evaluate people at high risk for prediabetes for whom they recommend practice-based laboratory testing.
Saeid Shahraz, M.D., Ph.D., of Tufts Medical Center, Boston, and coauthors used the risk test to estimate the proportion of the adult, nondiabetic U.S. population that would be classified as being at high risk for prediabetes.
The authors used data from the 2013-2014 National Health and Nutrition Examination Survey population and calculated risk scores for prediabetes based on seven questions. The questions included age, sex, family history of diabetes, history of gestational diabetes and high blood pressure, physical activity and weight. Among 10,175 survey participants, 96.5 percent had complete information for all the questions.
For people over 40, the estimated number to be at high risk for prediabetes was 73.3 million or 58.7 percent, according to the results. Among those participants 60 or older, the population proportion at high risk for prediabetes was 80.8 percent. A medical visit and blood glucose test are required for confirmation.
However, the authors caution that such a widespread process may be premature for a variety of reasons, including that according to the U.S. Preventive Services Task Force there is no direct evidence that type 2 diabetes prevention alters the risk for diabetes-related complications. Also, the natural history of prediabetes based on the latest American Diabetes Association criteria has not been studied prospectively to the authors' knowledge.
"Finally, medicalization of prediabetes may have the unintended consequence of reducing health care access to patients with type 2 diabetes and other chronic conditions. A valid method to examine for prediabetes should avoid unnecessary medicalization by labeling a disease predecessor as a medical condition and seek to concentrate on people at highest risk to allow for efficient distribution of limited health care resources," the research letter concludes.
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