Increase screening for 'prediabetes'. (HHS Recommendation).

WASHINGTON -- The epidemic growth of diabetes has prompted the Department of Health and Human Services to recommend screening all overweight people at age 45 for "prediabetes" and to consider screening younger, at-risk people such as those with a history of gestational diabetes.

This recommendation means that millions of Americans are now considered appropriate candidates for screening with fasting plasma glucose or oral glucose tolerance tests. (See chart, p.4.)

The announcement, made by HHS Secretary Tommy G. Thompson at a press briefing, is the product of a joint research panel of HHS, the American Diabetes Association, the National Institutes of Health, and the Centers for Disease Control and Prevention.

Patients with a fasting plasma glucose level between 110 and 125 mg/dL or a 2-hour oral glucose tolerance test value of 140-199 mg/dL should be considered at increased risk for developing type 2 diabetes. HHS is promoting diabetes testing as part of routine medical visits, although reimbursement issues remain to be worked out.

With no intervention, most people with elevated glucose levels develop type 2 diabetes within a decade, Secretary Thompson said. This pronouncement in support of early intervention is based on the finding of the Diabetes Prevention Program in which adults in the prediabetes category underwent modest lifestyle changes--diet and exercise-that reduced their risk of developing type 2 diabetes by more than 50%, compared with a control group (N. Engl. J. Med. 346[6]:393-403, 2002).

"Patients with prediabetes should be told that they have a serious condition, one that they can reverse with diet and exercise," Dr. Judith Fradkin of NIH said at the press conference. "With these changes, many patients can actually restore their blood glucose levels to normal."

The changes are modest--cutting calories and fat and walking 30 minutes per day 5 days per week--but even that is a challenge for many high-risk patients. HHS plans to endorse community support programs and a national program to spread the prevention message.