title: Reconsidering the age thresholds for type II diabetes screening in the U.S.
abstract: BACKGROUND
  Type II diabetes and its complications can sometimes be prevented, if identified and treated early. One fifth of diabetics in the U.S. remain undiagnosed. Commonly used screening guidelines are inconsistent.
  
  
  OBJECTIVE
  To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening, which is recommended by U.S. Preventive Services Task Force (USPSTF) and American Diabetes Association (ADA) guidelines.
  
  
  METHODS
  Cross-sectional analysis of a nationally representative sample from the National Health and Nutrition Examination Survey, 2007-2010. Number of people needed to screen (NNS) to obtain one positive test result was calculated for different guidelines. Sampling weights were applied to construct national estimates. The 2010 Medicare fee schedule was used for cost estimation. Analysis was conducted in January 2014.
  
  
  RESULTS
  NNS, under universal screening, drops sharply at age 35 years, from 80 (30-34-year-olds) to 31 (35-39-year-olds). Opportunistic universal screening of eligible people aged ≥35 years would yield an NNS of 15, translating to $66 per positive test. Among people aged 35-44 years (who are not recommended for universal screening by ADA), most (71%) were overweight or obese and all had at least one other ADA risk factor. Only 34% of individuals aged ≥35 years met USPSTF criteria. Strictly enforcing USPSTF guidelines would have resulted in a majority (61%) of potential positive test cases being missed (5,508,164 cases nationwide).
  
  
  CONCLUSIONS
  Opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed pre-diabetes or diabetes at relatively low cost.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto. Electronic address: chungs@pamfri.org.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Chung
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto.
authors.forename: Kristen M J
authors.initials: KM
authors.lastname: Azar
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto.
authors.forename: Marshall
authors.initials: M
authors.lastname: Baek
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, Illinois.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Lauderdale
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D050177:Overweight / Q000150:complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult