Screening for Diabetes AMERICAN DIABETES ASSOCIATION

D iabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes, the most prevalent form of the disease, is often asymptomatic in its early stages and can remain undiagnosed for many years. The chronic hyperglycemia of diabetes is associated with long-term dysfunction, damage, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Individuals with undiagnosed type 2 diabetes are also at significantly higher risk for stroke, coronary heart disease, and peripheral vascular disease than the nondiabetic population. They also have a greater likelihood of having dyslipidemia, hypertension, and obesity. Because early detection and prompt treatment may reduce the burden of diabetes and its complications, screening for diabetes may be appropriate under certain circumstances. This position statement provides recommendations for diabetes screenings performed in physicians’ offices and in other health care settings. This position statement does not address screening for type 1 diabetes or gestational diabetes mellitus (GDM). Because of the acute onset of symptoms, most cases of type 1 diabetes are detected soon after symptoms develop. Widespread clinical testing of asymptomatic individuals for the presence of autoantibodies related to type 1 diabetes cannot be recommended at this time as a means to identify persons at risk. Reasons for this include the following: 1) cutoff values for some of the immune marker assays have not been completely established in clinical settings; 2) there is no consensus as to what action should be taken when a positive autoantibody test result is obtained; and 3) because the incidence of type 1 diabetes is low, testing of healthy children will identify only a very small number ( 0.5%) who at that moment may be “prediabetic.” Clinical studies are being conducted to test various methods of preventing type 1 diabetes in high-risk individuals (e.g., siblings of type 1 diabetic patients). These studies may uncover an effective means of preventing type 1 diabetes, in which case targeted screening may be appropriate in the future. For information on screening for GDM, refer to the American Diabetes Association’s position statement “Gestational Diabetes Mellitus.”