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Clinical performance and health equity implications of the American Diabetes Association's 2023 screening recommendation for prediabetes and diabetes. | LitMetric

AI Article Synopsis

  • The American Diabetes Association (ADA) recommends that adults start being screened for prediabetes and diabetes at age 35, or younger if they are overweight or have other risk factors, but how this recommendation performs across different sociodemographic groups is unclear.
  • An analysis of data from the National Health and Nutrition Examination Surveys showed that about 83.1% of US adults qualify for screening based on ADA guidelines, with high sensitivity (95.0%) but low specificity (27.1%) across all groups, though women had slightly higher sensitivity compared to men.
  • The findings suggest that while the ADA's screening criteria work well overall, future research should explore how these guidelines are implemented in real-world settings and their impact on health

Article Abstract

Introduction: The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown.

Methods: Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity.

Results: An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA's screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (=0.04 and =0.02, respectively). Among women, guideline performance did not differ by race and ethnicity.

Discussion: The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611495PMC
http://dx.doi.org/10.3389/fendo.2023.1279348DOI Listing

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