NEW DIABETES SCREENING RECOMMENDATIONS

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The American Diabetes Association (ADA) has recommended wider screening for diabetes and a change in diagnostic criteria. The ADA predicts that the new protocol could identify 2 million of an estimated 8 million adults with undiagnosed diabetes.

Under the new guidelines, all adults should be administered a fasting plasma glucose (FPG) test at age 45 and, if the results are normal, every 3 years thereafter. The FPG, which is performed at least 8 hours after eating, is a test that measures the amount of glucose, or simple sugar, in the blood. High levels of glucose are interpreted as an indication that the sugar is not being transported into cells efficiently. The problem may be due either to resistance to insulin--a hormone that paves the way for the admission of glucose into cells--or, less frequently, to inadequate insulin levels.

Formerly, a FPG of 140 mg/dl was seen as an indication of diabetes. The ADA recommends lowering the threshold to 126 mg/dl. The new recommendations also peg 110 mg/dl as the upper limit of normal blood glucose and establish 110-126 mg/dl (impaired fasting glucose) as an indicator of high risk.

People who have glucose levels of 200 mg/dl or greater on the oral glucose tolerance test (OGT) are also considered to have diabetes. Although the OGT, which requires serum glucose measurement 2 hours after drinking a high-glucose beverage, is an accurate indicator of diabetes, it is less convenient and more expensive than the blood test. Another test, the finger-prick test used by people who have diabetes to monitor their blood glucose levels, is not precise enough to use diagnostically.

The ADA also recommends testing people under age 45 who:

Are more than 20% above ideal weight
Have a parent or sibling with diabetes
Are African-American, Hispanic, Native American, or Asian--high-risk ethnicities
Have borne a baby weighing more than 9 pounds or have had gestational diabetes
Have blood pressure at or above 140/90 mm Hg
Have HDL cholesterol of 35 mg/dl or less and/or triglycerides of 250 mg/dl or more
Have impaired fasting glucose or impaired glucose tolerance in previous testing.

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