Doctors should screen overweight and obese adults between 40 and 70 years old for abnormal blood sugar levels and type 2 diabetes, according to new recommendations from the U.S. Preventive Services Task Force.
People with elevated blood sugar (glucose) levels should then be referred to intensive behavioral counseling that emphasizes healthy eating and regular exercise, the guidelines say.
"People with abnormal blood glucose have a higher risk for progression to [type 2] diabetes. By finding abnormal blood glucose early, you may prevent that pathway by starting lifestyle interventions early," said Dr. Michael Pignone, a task force member and professor of medicine at the University of North Carolina at Chapel Hill.
As many as 86 million American adults have abnormal blood sugar levels. Without lifestyle changes, between 15 and 30 percent of them will develop type 2 diabetes within five years, according to background information in the guidelines.
Diabetes, which is increasingly prevalent in the United States, is a leading cause of heart attack and stroke, Pignone said.
Being overweight or obese is a significant risk factor for type 2 diabetes, Pignone said. What constitutes overweight? For a woman 5 feet 6 inches tall, overweight begins at about 155 pounds. Obesity for that same woman starts at 186 pounds, according to the U.S. National Heart, Lung, and Blood Institute. For a man 6 feet tall, overweight begins at 184 pounds, and obesity at 221.
Other modifiable risk factors include having a high percentage of abdominal fat, being physically inactive and smoking, the guidelines said.
Currently, the American Diabetes Association recommends routine screening in adults 45 years or older, and earlier screening in people with multiple risk factors for type 2 diabetes. A number of other health groups recommend screening for type 2 diabetes only in people who have risk factors, the new guidelines said.
The new recommendations were published in the Oct. 27 issue of the Annals of Internal Medicine.
The task force, an independent panel of experts in primary care and prevention, last issued guidelines on screening for blood sugar in 2008. The new review found six studies suggesting lifestyle-modification programs can help prevent type 2 diabetes, Pignone said. The research concerned people younger than 70, which is why the guidelines stop at that age, he added.
The task force recommends screening blood sugar using one of three inexpensive tests. One is a blood test that gives an estimate of what someone's blood sugar has been during the past two or three months.
The two other tests require fasting, so may be less convenient, Pignone said.
If your test results come back abnormal, the test should be repeated for confirmation, the guidelines advise.
For those who still have higher-than-normal blood sugar levels, the task force said the most helpful interventions combine multiple sessions of counseling to promote a healthy diet and physical activity. Such programs benefit blood sugar levels, and also help lower cholesterol and blood pressure levels, the authors said.
"Programs need to teach you the skills and habits that will be long-lasting. Three months of change, and then back to what you were doing before isn't likely to be effective," said Pignone.
Pignone said the YMCA has a worthwhile program that accepts people without health insurance. And now that the task force has changed its recommendation, screening and lifestyle interventions should be covered under the Affordable Care Act, he added.
The task force also found that medications can help lower blood sugar. But because of potential side effects, the task force didn't find a "net benefit" to drug therapy.
The new recommendations aren't radical, one expert said.
"I think most doctors are already doing this," said Dr. Howard Andrew Selinger, chair of family medicine at Quinnipiac University School of Medicine in Hamden, Conn.
The good news about lifestyle interventions is that they can be "simple, safe and cheap," Selinger said.
"While more commercial, formalized programs may be covered by insurance, if you want to help prevent type 2 diabetes, it doesn't have to cost anything," he said. "Open the front door and take a walk. Start with a 10-minute walk, and then work up to 20 minutes."
Selinger also said some major supermarket chains have nutritionists who can walk you through the store and "show you how to eat in a healthier way that you can afford."
