Clinical and Public Health Implications of 2019 Endocrine Society Guidelines for Diagnosis of Diabetes in Older Adults.
Diabetes Care
; 43(7): 1456-1461, 2020 07.
Article
en En
| MEDLINE
| ID: mdl-32327419
ABSTRACT
OBJECTIVE:
Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample. RESEARCH DESIGN ANDMETHODS:
We included 2,236 adults aged ≥65 years without known diabetes from the 2005-2016 National Health and Nutrition Examination Survey. Diabetes was defined using 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7-6.4% or FPG 100-125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7% to ≥9%). OGTT screening costs were estimated using Medicare fee schedules.RESULTS:
Diabetes prevalence was 15.7% (â¼5.0 million) using the Endocrine Society's approach and 7.3% (â¼2.3 million) using the standard approach. Treatment eligibility ranged from 5.4% to 0.06% and 11.8% to 1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c <6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c/FPG (â¼18.3 million) with OGTT could cost between $737 million and $1.7 billion.CONCLUSIONS:
Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
2_ODS3
Problema de salud:
2_muertes_prematuras_enfermedades_notrasmisibles
Asunto principal:
Tamizaje Masivo
/
Salud Pública
/
Guías de Práctica Clínica como Asunto
/
Diabetes Mellitus
/
Endocrinología
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Prevalence_studies
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
/
Screening_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Aged80
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Diabetes Care
Año:
2020
Tipo del documento:
Article
País de afiliación:
Moldova