At what age should patients be screened for Diabetes Mellitus (DM)?

From the Guidelines

Patients should be screened for Diabetes Mellitus (DM) at age 35 years.

Screening Guidelines

• The American Diabetes Association (ADA) recommends screening for prediabetes and type 2 diabetes in asymptomatic adults with overweight or obesity who have one or more risk factors, regardless of age 1.
• For all other people, screening should begin at age 35 years, with a minimum of 3-year intervals for repeat screening if results are normal 1.
• Risk-based screening for prediabetes or type 2 diabetes should be considered after the onset of puberty or after 10 years of age, whichever occurs earlier, in children and adolescents with overweight or obesity and who have one or more risk factors for diabetes 1.
• The ADA also suggests that screening be considered at a younger age or be carried out more frequently in high-risk individuals, such as those with a family history of diabetes, physical inactivity, or certain racial/ethnic backgrounds 1.

Key Considerations

• The evidence supports the use of fasting plasma glucose (FPG), 2-hour plasma glucose during a 75-g oral glucose tolerance test (OGTT), and A1C as appropriate screening tests for prediabetes and type 2 diabetes 1.
• Patients with prediabetes or type 2 diabetes should be tested regularly, with consideration of more frequent testing depending on initial results and risk status 1.
• Certain medications, such as glucocorticoids, statins, and thiazide diuretics, may also increase the risk of developing diabetes and should be considered when determining screening frequency 1.

From the Research

Screening Age for Diabetes Mellitus (DM)

The recommended age for screening patients for Diabetes Mellitus (DM) varies depending on the organization and the presence of risk factors.

• The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults ages 35 to 70 years with overweight or obesity for abnormal blood glucose 2.
• The American Diabetes Association (ADA) recommends screening all patients older than 45 years for prediabetes and diabetes, and screening earlier for patients with risk factors 3.
• For adults aged 40 to 70 years who are overweight or obese, the USPSTF recommends screening for abnormal blood glucose and type 2 diabetes, and repeating testing every three years if results are normal 4.
• Individuals at higher risk should be considered for earlier and more frequent screening 4.
• Screening all adults aged 35-70 years regardless of BMI yielded the most equitable performance across all racial and ethnic groups 5.

Risk Factors and Screening

The presence of risk factors can influence the recommended screening age for DM.

• The USPSTF suggests considering earlier screening in racial and ethnic groups with high diabetes risk at younger ages or lower BMI 5.
• The ADA recommends screening earlier for patients with risk factors, such as those with a family history of diabetes, physical inactivity, or a history of gestational diabetes 3.
• Lifestyle and pharmacologic interventions can decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance 4.

Diagnostic Criteria

The diagnostic criteria for prediabetes and diabetes require two abnormal test results from the same sample or from two separate samples, in the absence of unequivocal hyperglycemia or symptomatic hyperglycemia 3.

• A fasting plasma glucose level of 126 mg per dL or greater, an A1C level of 6.5% or greater, a random plasma glucose level of 200 mg per dL or greater, or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater can indicate diabetes 4.