February 2003 - The U.S. Preventive Services Task Force today recommended that adults with high blood pressure or high cholesterol be screened for Type II diabetes (insulin-resistant diabetes) as part of an integrated approach to reduce cardiovascular disease but concluded that further research is needed to determine whether widespread screening of the general population would improve health outcomes. In a separate recommendation, the Task Force found insufficient evidence to recommend for or against routine screening for gestational diabetes in asymptomatic pregnant women.
"So often diabetes does its damage by leading to other illnesses such as cardiovascular disease," Health and Human Services Secretary Tommy G. Thompson said. "I applaud the work of the Task Force for reinforcing the importance of prevention and early screening for people at higher risk for diabetes and its accompanying complications."
The Task Force is an independent panel of experts sponsored by the Agency for Healthcare Research and Quality. Its recommendations on screening for Type II diabetes are published in the February 4 issue of the Annals of Internal Medicine. The gestational diabetes recommendation is published in the February issue of the journal of Obstetrics & Gynecology (also known as The Green Journal).
Type II diabetes is the most common form of diabetes. Patients with Type II diabetes are at high risk for heart disease and stroke, and over time may develop eye, kidney or nerve problems. Type II diabetes is estimated to affect approximately 16 million Americans-11.1 million who have been diagnosed, and as many as 5.9 million who have not. Although diabetes frequently is accompanied by symptoms such as fatigue, excessive thirst or urination, it is often silent in its early stages. People at increased risk for diabetes include those who are obese; those who have a relative in their immediate family with the disease; and African Americans, Hispanics, and American Indians and Alaska Natives.
Gestational diabetes is a condition characterized by elevated blood sugar brought on by pregnancy. It occurs in approximately 2 percent to 5 percent of all pregnancies. Women who are older than 25, have had gestational diabetes in a previous pregnancy, or have a family history of diabetes are at higher risk for developing the disease. African American, Hispanic, American Indian and South or East Asian women are also at increased risk. Women with gestational diabetes are more likely to have large babies, which may lead to complications during labor or the need for Caesarean sections. According to the Task Force, it is not known whether small blood sugar elevations found in the majority of women with gestational diabetes have adverse effects for mother and infant.
Continue Reading Below ↓↓↓
"Although screening for gestational diabetes is a common part of prenatal care for pregnant women, the Task Force found insufficient evidence that routine screening for gestational diabetes substantially improves the health of mothers or their babies," said Task Force Chairman Alfred Berg, M.D., M.P.H., Professor and Chair, Department of Family Medicine, University of Washington, Seattle. "Identifying and appropriately treating women with more severe gestational diabetes reduces the number of women who have large babies, but the impact on important outcomes such as Caesarean section, complicated deliveries, or injuries to babies or mothers remains uncertain."
The Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on reports from teams at AHRQ's Evidence-based Practice Center at RTI International-University of North Carolina. The gestational diabetes report was led by Seth Brody, M.D., and the Type II diabetes report was led by Russell Harris, M.D., M.P.H.
The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against). The Task Force recommendations for Type II diabetes screenings are a "B" for those with high blood pressure or high cholesterol and an "I" for screening asymptomatic adults. The Task Force recommendation for gestational diabetes screening is an "I" for screening asymptomatic pregnant women.
The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstfix.htm. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available at that Web address as well. This information also can be obtained from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an E-mail to [email protected]. Clinical information is also available from the National Guideline Clearinghouse� at http://www.guideline.gov.
Source: AHRQ
