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Screening for Type 2

Mar 10, 2018

A patient that you haven’t seen for several years comes to your clinic for a wellness check-up. Since her last visit, she has gained about 15 pounds (5’6”, BMI 27 kg/m2). Her stage 1 hypertension is controlled with hydrochlorothiazide. As you discuss her weight gain, you learn that she doesn’t get more than 30 minutes a week of physical activity. You decide it would be best to check her A1C. Which of the following information from her history leads you to screen her for type 2 diabetes?


Correct answer: D. She has a history of hypertension

Educational Critique:

According to the ADA standards, hypertension (BP=140/90 or on therapy for hypertension) in conjunction with BMI = 25 kg/m2 is an indication for diabetes screening in asymptomatic adults. The ADA’s criteria for testing for diabetes in asymptomatic adult individuals follows:

Testing should be considered in all adults who are overweight (BMI=25/kg/m2)* and have an additional risk factor (*at-risk BMI may be lower in some ethnic groups), including:

  • Physical inactivity
  • First-degree relative with diabetes
  • High-risk race/ethnicity (e.g. African American, Latino, Native American, Asian American, Pacific Islander
  • Women who delivered a baby weighing >9 lb or were diagnosed with GDM
  • Hypertension (=140/90 mmHg or on therapy for hypertension)
  • HDL cholesterol level<35 mg/dL (0.90 mmol/L) and/or triglyceride level.250 mg/dL (2.82 mmol/L)
  • Women with polycystic ovary syndrome
  • A1C=5.7%, IGT, or IFG on previous testing
  • Other clinical conditions associated with insulin resistance (e.g. severe obesity, acanthosis nigricans)
  • History of CVD

In the absence of the above criteria, testing for diabetes should begin at age 45 years. If the results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly and risk status).  The 2018 Standards of Medical Care in Diabetes