Screening for Dysglycemia: Connecting Supply and Demand to Slow Growth in Diabetes Incidence

Citation: Ali MK, Narayan KMV (2016) Screening for Dysglycemia: Connecting Supply and Demand to Slow Growth in Diabetes Incidence. PLoS Med 13(7): e1002084. doi:10.1371/journal.pmed.1002084
Published: July 19, 2016

Diabetes is one of the most devastating and costly conditions worldwide, leading to substantial burdens of macro- and microvascular diseases, as well as other disorders. Armed with evidence from randomized controlled trials [1–3] and other data showing that progression to type 2 diabetes can be effectively [4] and cost-effectively [5] delayed among people at high risk, several countries have embarked on rolling out prevention programs to slow the growing incidence of diabetes. Such programs center on evidence-based behavior change interventions aimed at promoting healthy diets, appropriate physical activity, and modest weight loss. The most recent initiatives include the United States government’s authorization for diabetes preventive services to be covered for Medicare beneficiaries [6] and the launch by the United Kingdom’s National Health Service of a nationwide diabetes prevention program [7]. However, for these endeavors to successfully mitigate growing diabetes burdens, several important barriers to implementation of prevention strategies need to be overcome (Fig 1), and screening for dysglycemia is a key part of this process to connect demand with a growing supply of preventive services.

Screening for Dysglycemia.1002084.g001

Fig 1. A framework for enhancing diabetes prevention and management supply and demand.

The principle that underlies screening for dysglycemia is to accurately identify risk of type 2 diabetes without causing physical or psychological harm and to motivate at-risk individuals to connect with appropriate health care and preventive services. While definitions of prediabetes vary, people with elevated fasting or 2-hour glucose, hemoglobin A1c, or any combination of these, albeit not in the diabetes range, have a 4–12 times higher annual likelihood of developing diabetes than the general, normoglycemic population [8]. Screening is therefore pertinent to identify these persons, especially since nearly 47% of the 415 million people with diabetes worldwide, and a substantial yet unquantified proportion of those with prediabetes, remain unaware of their condition [9]. Even in high-income countries like the US, over a quarter of the 29 million Americans with diabetes [10] and nearly 90% of the 86 million with prediabetes are not aware of their condition [11]. These awareness gaps are likely to impede success of evidence-based interventions to prevent diabetes and its complications among adults with both prediabetes and diabetes.


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