Test All Patients Over Age 30 at Risk for Diabetes. (New Diabetes Guidelines).

WASHINGTON - New guidelines call for a major expansion of screening for diabetes, urging physicians to test any patient over age 30 at increased risk for the disease.

The guidelines, issued in August by the American College of Endocrinology and the American Association of Clinical Endocrinologists, cite a list of risk factors that include a history of polycystic ovarian disease or gestational diabetes and having given birth to a baby weighing 9 pounds.

Other risk factors include cardiovascular disease, a family history of diabetes, overweight, a sedentary lifestyle, impaired glucose tolerance or impaired fasting glucose, hypertension, and high triglyceride or low high-density lipoprotein cholesterol levels.

Moreover, all people of Latino I Hispanic, African American, Native American, and Pacific Islander ethnicity should be screened starting at age 30, according to the guidelines.

A dramatic tightening of the hemoglobin [A.sub.1.c] [HbA.sub.1c.] target for treating diabetes is another key objective of the guidelines. The guidelines set a goal of 6.5% as the primary indicator of glycemic control in type 1 and type 2 diabetes-a goal that many physicians view as unreasonably ambitious and not well justified.

Calling the guidelines "controversial," the American Academy of Family Physicians stated that "organizations that use an evidence-based approach to developing screening recommendations, including the U.S. Preventive Services Task Force and the AAFP, do not recommend screening asymptomatic persons for diabetes and suggest that target [HbA.sub.1c] levels be individualized."

A key issue is whether a change in practice is warranted based on findings from a major trial known as the UK Prospective Diabetes Study (UKPDS), said Dr. Kenneth C. Shellhase of the Medical College of Wisconsin, Milwaukee.