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Should Screening for Type 2 Diabetes Be More Aggressive?

Nov 7, 2020
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Alexandria Bartley, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

Earlier diagnosis and treatment prevent complications: the case for screening for type 2 at younger ages.

In the United States, diabetes is one of the leading causes of death and morbidity. Currently, in the U.S. Preventive Services Task Force (USPSTF) guidelines, it is recommended to screen asymptomatic patients who are older than 40 years of age, and have obesity or overweight. The optimal goal is to start screening patients earlier than the age of 40 for diabetes. The variable cost, such as direct wages, materials, and labor for type 2 diabetes, is persistently rising. The direct cost increased from an alarming one hundred and sixteen billion to an even more dreadful two hundred and thirty-seven billion within just a ten-year time frame. This study will support screening a significant percentage of patients susceptible to being diagnosed with type 2 diabetes, specifically those between 18 and 39 years old. Based on a simple self-reported questionnaire the researchers conducted, one-fourth of patients were diagnosed with type 2 diabetes before 40 years of age. In previous studies, the cost-benefit ratio of screening for type 2 diabetes in patients with obesity or overweight aged 45 to 75 was examined. No study has been conducted to include the younger population.  


The purpose of this cross-sectional study was, ultimately, to get the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), and International Diabetes Federation (IDF) guidelines altered to include screening patients who were younger than 40 years old for type 2 diabetes. The total sample size of this study was 25,461. This number denoted an adult U.S. population size of N= 235,483,332. The outcome being measured was the number of patients reporting being diagnosed before 40 years of age with type 2 diabetes. The type 2 diabetes prevalence was determined by the patient’s response to these three questions asked by researchers: “Have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes; what type of diabetes do you have; and, how old were you when a doctor first told you that you had diabetes or sugar diabetes?” Chi-squared test was the statistical test used to determine the diagnosis rates of type 2 diabetes in groups by age, race, and sex. 

About 8.12% (95%CI: 7.72–8.55) stated being diagnosed with type 2 diabetes based on the sample size. Of that amount, there was 24.53% (95%CI: 22.15–27.08) of patients diagnosed with type 2 diabetes before the age of 40 years. In the real world, this number symbolizes approximately 4.6 million people. Comparing women to men, women had more rates of diabetes diagnoses before 40 years of age (X2: F(1.87, 472.45) = 3.3813; p < .05). Lastly, the prevalence of patients aged 18 to 39 years old with obesity or overweight was (58.28% (95%CI: 56.78–59.77). All races minus Asian-American had more than 50% of patients with obesity or overweight and between the ages 18 to 39 years old. Also, in this study, it was concluded that a patient ethnic background did not necessarily have a significant clinal value in indication for type 2 diabetes diagnosis before the age of 40, even though there were more than 66% of white patients diagnosed with type 2 diabetes.  

Future studies should be done once the age for screening patients for type 2 diabetes is lowered. The research should be concentrated on cost minimalization. Therefore, the cost-benefit ratio should be investigated. This study also recognized that females have a higher prevalence of developing type 2 diabetes before 40. However, the results cannot determine if this is due to female patients being subjected to gestational diabetes screening during childbearing ages. There could have been some bias in this study due to the type of study it was, and due to the fact that patients self-reported information.  

Practice Pearls: 

  • About 11.6% of patients who are less than 30 years of age are diagnosed with type 2 diabetes. 
  • An earlier diagnosis of type 2 diabetes can eventually decrease or prevent patients from developing complications resulting from untreated type 2 diabetes.  
  • Lowering the screening age for diabetes can decrease the projected prevalence over the next twenty-plus years.  


Greiner B, Mercer H, Raymond C, Sonstein L, Hartwell M. A recommendation for earlier screening of type 2 diabetes mellitus within the U.S. population: A cross-sectional analysis of NHIS data. Diabetes Res Clin Pract. 2020;168. doi:10.1016/j.diabres.2020.108376 


Alexandria Bartley, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences 



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