Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity

Introduction: In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended prediabe-tes and diabetes screening for asymptomatic adults aged 35-70 years with overweight/obesity, low-ering the age from 40 years in its 2015 recommendation. The USPSTF suggested considering earlier screening in racial and ethnic groups with high diabetes risk at younger ages or lower BMI. This study examined the clinical performance of these USPSTF screening recommendations as well as alternative age and BMI cutoffs in the U.S. adult population overall, and separately by race and ethnicity.Methods: Nationally representative data were collected from 3,243 nonpregnant adults without diagnosed diabetes in January 2017-March 2020 and analyzed from 2021 to 2022. Screening eligi-bility was based on age and measured BMI. Collectively, prediabetes and undiagnosed diabetes were defined by fasting plasma glucose >= 100 mg/dL or hemoglobin A1c >= 5.7%. The sensitivity, specificity, and predictive values of alternate screening criteria were examined overall, and by race and ethnicity.Results: The 2021 criteria exhibited marginally higher sensitivity (58.6%, 95% CI=55.5, 61.6 vs 52.9%, 95% CI=49.7, 56.0) and lower specificity (69.3%, 95% CI=65.7, 72.2 vs 76.4%, 95% CI=73.3, 79.2) than the 2015 criteria overall, and within each racial and ethnic group. Screening at lower age and BMI thresholds resulted in even greater sensitivity and lower specificity, especially among His-panic, non-Hispanic Black, and Asian adults. Screening all adults aged 35-70 years regardless of BMI yielded the most equitable performance across all racial and ethnic groups.Conclusions: The 2021 USPSTF screening criteria will identify more adults with prediabetes and dia-betes in all racial and ethnic groups than the 2015 criteria. Screening all adults aged 35-70 years exhib-ited even higher sensitivity and performed most similarly by race and ethnicity, which may further improve early detection of prediabetes and diabetes in diverse populations.

Automated summary

In 2021, the USPSTF recommended prediabetes and diabetes screening for asymptomatic adults aged 35-70 years with overweight/obesity. The study found that the 2021 criteria had higher sensitivity and lower specificity compared to the 2015 criteria, and screening all adults aged 35-70 years regardless of BMI had the most equitable performance across racial and ethnic groups.