Fasting Glucose Screening is Most Recommended
For this 47-year-old woman with controlled hypertension and BMI of 32, fasting glucose screening (Option D) is the most appropriate choice because she meets multiple high-risk criteria that mandate diabetes screening according to established guidelines. 1
Why Fasting Glucose Takes Priority
This patient has two major risk factors that specifically trigger diabetes screening recommendations:
Hypertension (controlled for 5 years): The USPSTF provides a Grade B recommendation for screening adults with hypertension for type 2 diabetes, with moderate certainty that this leads to substantial benefit in preventing cardiovascular events and death 1
Obesity (BMI 32): The American Diabetes Association recommends screening in adults with BMI ≥25 kg/m², and this patient significantly exceeds that threshold 1
Age 47 years: Multiple guidelines recommend screening beginning at age 45, and she is already past this threshold 1
Evidence Supporting This Choice
The combination of hypertension and obesity creates compounded cardiovascular risk. Undiagnosed diabetes in hypertensive patients substantially elevates cardiovascular morbidity and mortality well before clinical diagnosis 1. The Canadian Task Force found fair evidence (Grade B) specifically for screening adults with hypertension to prevent cardiovascular events and death 1.
Research demonstrates that nearly one-third of adults with hypertension remain unscreened for diabetes, representing missed opportunities for early detection and cardiovascular risk reduction 2. The presence of hypertension doubles the impact of obesity on metabolic complications, particularly in women 3.
Why Other Options Are Less Appropriate
Pap smear (Option B): While cervical cancer screening remains important, standard guidelines recommend screening every 3-5 years for women in this age group with normal prior results. This is not the "most recommended" screening given her specific risk profile
Fecal occult blood (Option C): Colorectal cancer screening typically begins at age 45-50, making this reasonable but not the highest priority given her immediate cardiovascular risk factors
CT screening (Option A): Without additional context (smoking history for lung cancer screening, for example), this is not indicated as routine screening
Implementation Approach
Screen with fasting plasma glucose as the initial test. A result ≥126 mg/dL on two separate occasions confirms diabetes diagnosis 4. Alternatively, HbA1c ≥6.5% can be used 4.
If results show impaired fasting glucose (100-125 mg/dL), this patient requires:
- Intensive lifestyle intervention targeting weight reduction and increased physical activity 1
- Repeat screening annually given her high-risk status 1
- Aggressive cardiovascular risk factor management 1
Critical Clinical Pitfall
Do not delay diabetes screening in hypertensive patients, even when blood pressure is "controlled." The metabolic abnormalities often precede overt diabetes diagnosis by years, and cardiovascular risk is substantially elevated during this pre-diagnostic period 1. The combination of hypertension and obesity creates a 2-fold increased risk for developing diabetes compared to either factor alone 3.
Given her controlled hypertension, ensure screening occurs at least annually rather than the standard 3-year interval recommended for lower-risk populations 1.