From the Guidelines
To effectively screen for diabetes at a public health event, focus on identifying individuals with risk factors such as age over 45, family history of diabetes, physical inactivity, and being overweight or obese, as these factors are strongly associated with an increased risk of developing type 2 diabetes 1. When assessing individuals for diabetes screening, consider the following key factors:
- Age: particularly if over 45 years old, as the risk of developing type 2 diabetes increases with age 1
- Family history: of diabetes, especially in first-degree relatives, which can significantly increase an individual's risk 1
- Physical activity levels: regular physical activity can help prevent or delay the onset of type 2 diabetes, so it's essential to assess an individual's physical activity levels 1
- Weight status: being overweight or obese is a significant risk factor for type 2 diabetes, so assessing an individual's weight status is crucial 1
- Symptoms: such as frequent urination, excessive thirst, unexplained weight loss, blurred vision, or slow-healing wounds, which can indicate the presence of diabetes 1
- Medical history: of high blood pressure, high cholesterol, or cardiovascular disease, which can increase an individual's risk of developing diabetes-related complications 1
- Ethnicity: certain ethnic groups, such as African Americans, Hispanic/Latino Americans, Native Americans, Asian Americans, and Pacific Islanders, have a higher risk of developing diabetes 1
- Other factors: such as history of polycystic ovary syndrome, delivering babies weighing over 9 pounds, smoking status, and sleep patterns, which can also impact an individual's risk of developing diabetes 1 The Finnish Diabetes Risk Score, as described in the study by 1, can be a useful tool to assess an individual's risk of developing type 2 diabetes, taking into account factors such as age, body mass index, waist circumference, physical activity levels, and family history of diabetes. By focusing on these key factors and using a risk assessment tool, healthcare providers can identify individuals who would benefit from blood glucose testing and early intervention to prevent diabetes-related complications.
From the Research
Screening Questions for Diabetes
To determine who could be screened for diabetes at a public health event, the following questions can be asked:
- Are you aged 35 to 70 years? 2
- Do you have overweight or obesity, defined as a body mass index ≥25 and ≥30, respectively? 2
- Are you asymptomatic, meaning you do not have any symptoms of diabetes? 2
- Have you had a previous diagnosis of prediabetes or diabetes?
- Do you have a family history of diabetes?
- Are you physically inactive?
- Do you have a history of cardiovascular disease or other conditions associated with an increased risk of diabetes?
Additional Considerations
When screening for gestational diabetes, additional questions can be asked, such as:
- Are you pregnant or planning to become pregnant?
- Have you had a previous diagnosis of gestational diabetes?
- Do you have a history of delivering a large-for-gestational-age infant?
- Do you have a history of hypertensive disorders of pregnancy?
Fasting Plasma Glucose Levels
Fasting plasma glucose levels can also be used to guide the need for an oral glucose tolerance test (OGTT) to screen for gestational diabetes mellitus 3, 4. A fasting plasma glucose level of < 78 mg/dL or < 4.4 mmol/l can be used to rule out gestational diabetes, while a level of ≥ 5.3 mmol/l can be used to rule in gestational diabetes 3, 4. Elevated fasting plasma glucose levels are also associated with an increased risk of large-for-gestational-age and hypertensive disorders of pregnancy outcomes in gestational diabetes pregnancies 5.
Prepregnancy Fasting Plasma Glucose Variability
Increased prepregnancy fasting plasma glucose variability is associated with the risk of gestational diabetes, independent of confounding factors 6. This association is intensified in obese and aged more than 35 years women 6.