title: Diabetes and lipid screening among patients in primary care: a cohort study.
abstract: BACKGROUND
  Obesity is associated with increased cardiovascular diseases and diabetes mellitus. Guidelines call for intensified glucose and lipid screening among overweight and obese patients. Data on compliance with these guidelines are scarce. The purpose of this study was to assess rates of diabetes and lipid screening in primary care according to demographic variables and weight status.
  
  
  METHODS
  Over a 3-year follow-up period, we assessed screening rates for blood glucose, triglycerides, and HDL- and LDL-cholesterol among 5025 patients in primary care. From proportional hazards models we estimated screening rates among low, moderate, high, and very-high risk patients and compared them with recommendations of the American Diabetes Association (ADA), National Cholesterol Education Program (ATP III) and U.S. Preventive Services Task Force (USPSTF).
  
  
  RESULTS
  Mean (SD) age was 47.4 (15.6); 69% were female, 21% were non-white, and 30% of males and 25% of females were obese (BMI > or = 30 kg/m2). For both diabetes and lipid screening, the adjusted hazard was 260-330% higher among > or = 65 than < 35 year-olds, 50-90% higher in persons with BMI > or = 35 than < 25 kg/m2, 10-30% lower for females than males, and not lower among racial/ethnic minorities. Screening rates were at least 80% among very-high risk persons, which we defined as 55-64 years old, BMI > or = 35 kg/m2, non-white, with baseline hypertension. In contrast, high-risk persons who were younger (35-44 years old) and less obese (BMI 30-<35 kg/m2) were screened less often (43% for LDL-cholesterol among females to 83% for diabetes among males) even though ADA, ATP III and USPSTF recommend diabetes and lipid screening among them.
  
  
  CONCLUSIONS
  Patients with higher BMI or age were more likely to be screened for cardiometabolic risk factors. Women were screened at lower rates than men. Even in a highly structured medical group practice, some obese patients were under-screened for diabetes and dyslipidemia.
authors.affiliation: Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, Massachusetts 02215, USA. sheryl_rifas@harvardpilgrim.org
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: John P
authors.initials: JP
authors.lastname: Forman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Lane
authors.forename: Herve
authors.initials: H
authors.lastname: Caspard
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis* / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000639:trends*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011320:Primary Health Care; D016016:Proportional Hazards Models; D014481:United States
chemical_list: D008055:Lipids