Reasons for the Updates

Regarding the reason for the changes between the two versions, Hannah Changi, a USPSTF media support representative, told Endocrinology Advisor that “the Task Force received feedback during the public comment period that called for a clearer understanding of who to screen. As a result, the final recommendation was updated to reflect the population most likely to have abnormal blood sugar.”

When asked about the specific studies that informed the parameters of the new guideline, she said, “The Task Force does not grade studies individually and instead reviews all the evidence available to determine the net benefit of the preventive service.”


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Another update the USPSTF made in response to public feedback was the provision for more details regarding the most successful lifestyle interventions for diabetes prevention. The Task Force concluded that lifestyle changes may be more beneficial than medications in reducing progression to the disease, based on 10 studies included in a systematic review published in June 2015 in the Annals of Internal Medicine.7

One such study, for example, is a randomized trial reported in a 2012 issue of the Journal of General Internal Medicine showing that an intensive lifestyle program, as compared with metformin, was associated with greater improvements in health-related quality-of-life scores in overweight patients who were at high risk for diabetes.8

Also, in research reported in Diabetologia in 2009, one group of Asian Indian patients underwent lifestyle modification plus placebo, while another group received pioglitazone along with the lifestyle modification.9 Each intervention was found to have a comparable impact on preventing conversion to diabetes, and pioglitazone was not shown to have any greater effect than placebo. 

“We found that treating those who have abnormal blood sugar with intensive lifestyle interventions may decrease their risk of progression to diabetes and lower overall mortality,” said Dr Pignone. “These intensive lifestyle modifications included improved nutrition, healthy eating behaviors, and increased physical activity,” which are best supported in the context of a behavioral counseling program.

Looking Ahead

While the new guideline is an improvement over the 2008 version in that it recognizes age and weight as important risk factors, “more still needs to be done to slow the diabetes epidemic and quickly diagnose and treat new cases,” said Dr Lash.

“The Endocrine Society and other members of the diabetes community are working together to engage policymakers to take action,” such as approval of funding for the National Diabetes Prevention Program10, and the extension of coverage of continuous glucose monitors to the Medicare population.

“Policies like these would go a long way toward reducing the number of people who are diagnosed with diabetes and avoiding costly complications among those who already have the condition,” he said.

References

  1. Siu AL; for the U.S. Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;doi:10.7326/M15-2345.
  2. National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention website. http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html. Updated May 15, 2015. Accessed November 23, 2015.
  3. DAA Press Statement on USPSTF Draft Diabetes Screening Recommendation [news release]. Diabetes Advocacy Alliance; October 9, 2014. http://www.diabetesadvocacyalliance.org/media/DAA_press_statement_on_USPSTF_draft
    _diabetes_screening_recommendation-Final-10-09-2014.pdf
    . Accessed November 23, 2015.
  4. Diabetes Advocacy Alliance Deeply Disappointed in Final USPSTF Diabetes Screening Recommendation [news release]. Diabetes Advocacy Alliance; October 27, 2015. http://www.diabetesadvocacyalliance.org/media/DAA-Press-Statement-102715.pdf. Accessed November 23, 2015.
  5. Chow EA, Foster H, Gonzalez V, McIver L. The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations. Clin Diabetes. 2012;30(3):130-133.
  6. The American Diabetes Association Disappointed in Scope of New Screening Guidelines for Type 2 Diabetes And Pleased with Expansion of Lifestyle Interventions [press release]. Alexandria, Virginia: American Diabetes Association; October 26, 2015. http://www.diabetes.org/newsroom/press-releases/2015/uspstf-new-screening-guidelines-for-type-2-diabetes.html. Accessed November 23, 2015. 
  7. Selph S, Dana T, Blazina I, Bougatsos C, Patel H, Chou R. Screening for Type 2 Diabetes Mellitus: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(11):765-776.
  8. Florez H, Pan Q, Ackermann RT, et al. Impact of Lifestyle Intervention and Metformin on Health-Related Quality of Life: the Diabetes Prevention Program Randomized Trial. J Gen Intern Med. 27(12):1594-1601.
  9. Ramachandran A, Snehalatha C, Mary S, et al. Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2). Diabetologia. 2009;52(6):1019-1026.
  10. National Diabetes Prevention Program. Centers for Disease Control and Prevention website. http://www.cdc.gov/diabetes/prevention. Update April 20, 2015. Accessed November 23, 2015.