Evidence-Based Reviews

Diabetes screening: Which patients, what tests, and how often?

Current Psychiatry. 2009 March;8(3):19-23

References

1. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27(2):596-601.

2. U.S. Preventive Services Task Force. Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148(11):846-854.

3. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):S13-61.

4. Rodbard HW, Blonde L, Braithwaite SS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13(suppl 1):1-68.

5. Rydén L, Standl E, Bartnik M, et al. Guidelines on diabetes, pre-diabetes and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardio-vascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28(1):88-136.

6. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.

Other practitioners can be more or less conservative and still be within accepted guidelines. The FPG—glucose level drawn from a vein after at least 8 hours of fasting—is probably the easiest screening test in practice. Any patient with a value >100mg/dL should be referred to the patient’s primary care physician. Any patient who develops diabetes symptoms—including polyuria, polydipsia, and weight loss—should be tested immediately. The hemoglobin A1C test is not recommended for screening.

Table 2

Risk factors identified for diabetes or prediabetes

American Diabetes Association (ADA)	BMI >25 kg/m² physical inactivity first-degree relative with diabetes members of high-risk ethnic populations (African-American, Latino, Native American, Asian, Pacific Islander) women who delivered a baby >9 lb or had gestational diabetes hypertension high-density lipoproteins cholesterol <35 mg/dL and/or triglyceride level >250 mg/dL women with polycystic ovarian syndrome impaired glucose tolerance or impaired fasting glucose on previous testing conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans history of cardiovascular disease
American Association of Clinical Endocrinologists	All of the risk factors identified by the ADA, except for conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans psychiatric illness

American Diabetes Association (ADA)

BMI >25 kg/m²
physical inactivity
first-degree relative with diabetes
members of high-risk ethnic populations (African-American, Latino, Native American, Asian, Pacific Islander)
women who delivered a baby >9 lb or had gestational diabetes
hypertension
high-density lipoproteins cholesterol <35 mg/dL and/or triglyceride level >250 mg/dL
women with polycystic ovarian syndrome
impaired glucose tolerance or impaired fasting glucose on previous testing
conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans
history of cardiovascular disease

American Association of Clinical Endocrinologists

All of the risk factors identified by the ADA, except for conditions associated with insulin resistance, such as severe obesity or acanthosis nigricans
psychiatric illness

Clinical presentation

Screening detects overt diabetes and can identify prediabetes. Prediabetes includes conditions of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). IFG is defined as a fasting glucose of 100 to 125 mg/dL, and IGT is defined as having a 2-hour glucose of 140 to 199 mg/dL on an OGTT.

Approximately one-quarter of the adult population has prediabetes, and interventions can prevent the progression of prediabetes to overt diabetes and reverse prediabetes. The Diabetes Prevention Trial found that lifestyle measures—including exercise and diet—were most effective, with a 53% reduction in the rate of progression to diabetes.⁶ Metformin also was effective, but less so than lifestyle measures alone.

Treatment slows the development or progression of microvascular complications, such as retinopathy, nephropathy, and neuropathy. Aggressive treatment of comorbid conditions, including hyperlipidemia and hypertension, also reduces the risk of cardiovascular events.

Clinical Point

Treatment slows the progression of microvascular complications, such as retinopathy, nephropathy, and neuropathy

Drug brand names

Aripiprazole • Abilify
Metformin • Glucophage
Ziprasidone • Geodon

Related resources

American Diabetes Association. Diabetes risk calculator. www.diabetes.org/risk-test.jsp.
Dagogo-Jack S. The role of antipsychotic agents in the development of diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2009;5(1):22-23. Quick, up-to-date review of the association between atypical antipsychotics and diabetes mellitus.

Disclosure

Dr. Keenan reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Diabetes screening: Which patients, what tests, and how often?

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