SCREENING GUIDELINES
Type 1 diabetes At this time, there is a deficit of accepted and clinically validated screening programs outside of research settings. The ADA recommends considering referring relatives of those with type 1 diabetes for islet autoantibody testing for risk assessment in the
● Screening for type 1 diabetes risk with a panel of islet autoantibodies is currently recommended in the setting of a research trial or can be offered as an option for firs-degree family members of a proband with type 1 diabetes. The proband is the first individual to be studied in a family. ● Persistence of autoantibodies is a risk factor for clinical diabetes and may serve as an indication for intervention in the setting of a clinical trial. ● To test for prediabetes and type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are equally appropriate. ● In patients with prediabetes and type 2 diabetes, identify and treat other cardiovascular disease risk factors. ● Risk-based screening for prediabetes and/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 (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and who have one or more risk factor for diabetes. ● Patients with HIV should be screened for diabetes and prediabetes with a fasting glucose test before starting antiretroviral therapy, at the time of switching antiretroviral therapy, and three to six months after starting or switching antiretroviral therapy. If initial screening results are normal, fasting glucose should be checked annually.
setting of a clinical research study. (ADA, 2021b). Current ADA (2021b) recommendations include:
Prediabetes and type 2 diabetes The 2021 ADA screening guidelines list the same recommendations for both prediabetes and type 2 diabetes. These include (ADA, 2021b): ● Screening for prediabetes and type 2 diabetes with an informal assessment of risk factors or validated tools should be considered in asymptomatic adults. ● Testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity (BMI ≥25 kg/m2 or ≥23 kg/ m2 in Asian Americans) and who have one or more additional risk factors for diabetes ● Testing for prediabetes and/or type 2 diabetes should be considered in women with overweight or obesity planning pregnancy and/or who have one or more additional risk factor for diabetes. ● For all people, testing should begin at age 45 years. ● If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable, sooner with symptoms.
RISK FACTORS
Risk factors for the development of type 1 diabetes A number of risk factors are associated with the development of type 1 diabetes (American Heart Association, 2021; Mayo Clinic, 2020a): ● Family history Risk factors for the development of type 2 diabetes There are several risk factors related to the development of type 2 diabetes mellitus. These risk factors are classified as Nonmodifiable risk factors The following risk factors are nonmodifiable; in other words, they cannot be changed (American Heart Association, 2021; CDC, 2021b; Mayo Clinic, 2020a): ● Age: Risk increases with age. This increase seems to begin at the age of 40 ● Race and ethnicity: Some racial and ethnic groups have a higher incidence of type 2 diabetes than others. These include: ○ African Americans ○ Asian-Americans ○ Latino/Hispanic-Americans ○ Native Americans ○ Pacific Islander descent Modifiable risk factors The following risk factors are those that can be modified or changed to decrease risk of developing type 2 diabetes. Overweight/Obesity Being obese or overweight is one of the greatest risk factors for type 2 diabetes. Because obesity is increasing among children and adolescents, type 2 diabetes is affecting more and more young people (American Heart Association, 2021; Taylor, 2020b). The body mass index, or BMI, is the standard to determine overweight and obesity. BMI is a person’s weight in kilograms divided by the square of height in meters. According to CDC, the following BMI measures indicate underweight, normal, overweight, and obesity (CDC, 2021a):
● Exposure to a viral illness ● Presence of autoantibodies ● Geography (Some countries, including Finland and Sweden, have higher rates of type 1 diabetes)
nonmodifiable and modifiable.
● Family history: A person’s chances of developing type 2 diabetes increases if immediate or even extended family members have the disease. ● History of gestational diabetes: Women who have gestational diabetes have a greater risk of developing prediabetes and type 2 diabetes. Having given birth to a baby that weighs more than 9 pounds also increases risk. Healthcare Professional Consideration: Although research has shown that certain risk factors cannot be modified, healthcare professionals must still include them in patient/family education and be aware of such factors that increase the risk for development of diabetes. ● Obese: BMI is 30.0 or higher Fortunately, even a small loss of weight can have a significant impact on health and longevity. Lifestyle modifications to achieve weight loss include the following: ● Reduction in caloric intake: Patients should work with their health care providers, including a clinical dietician as necessary, to implement a well-balanced diet that will facilitate weight loss (Ignatavicius et al., 2018). ● Increase in physical activity: The American Heart Association (2021) and CDC, 2020a) publishes the following physical activity guidelines for adult Americans: ○ Two hours and 30 minutes (150 minutes) of moderate- intensity aerobic activity every week and muscle strengthening activities that work all major muscle groups two or more days a week OR
● Underweight: BMI is < 18.5 ● Normal: BMI is 18.5 to <25 ● Overweight: BMI is 25.0 to <30
Book Code: ANCCUS2423
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