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Can five years really make a difference in preventing diabetes? We think so.

Dr. Jason
Paruthi
September 8, 2021
Can five years really make a difference in preventing diabetes? We think so.
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The US Preventive Services Task Force (USPSTF) recently lowered their recommended starting age of screening for prediabetes and type 2 diabetes to 35 years for adults who are overweight or obese. This is a grade B recommendation, meaning the USPSTF concludes with moderate certainty that screening for prediabetes and type 2 diabetes and offering or referring patients with prediabetes to effective preventive interventions has a moderate net benefit.

With this lowering of the age recommendation from age 40 to age 35, more than 40% of US adults will now be eligible for screening for prediabetes. As 88 million Americans are estimated to have prediabetes, this could result in millions of additional people being diagnosed with prediabetes and subsequently seeking treatment across the United States.

It’s never too early to get healthy

Many advocates are pointing to the positives of early detection, as early interventions aimed at improving nutrition and increasing physical activity can be low cost with wide access and great impact. The earlier anyone can start thinking about and implementing preventative behaviors, the better. One way to think about diabetes prevention is to apply what health experts often refer to as the three types of prevention of cardiovascular disease: primordial prevention, primary prevention, and secondary prevention. Primordial prevention means working to prevent health risk factors from childhood. Primary prevention is typically aimed at people who have already developed cardiometabolic risk factors such as high blood pressure or prediabetes as they get older, but have not yet had a cardiovascular event such as a heart attack or stroke. Once such an event has occurred, with expensive procedures and hospital stays, secondary prevention is then critical to prevent another cardiovascular event that the person may not survive.

Thus, although this five year age change recommendation may sound small, it could have a large impact. As Grant, et al. write in their editorial in JAMA Internal Medicine, “Lowering the age for screening may facilitate earlier recognition of diabetes, including in the racial and ethnic groups at highest risk, and holds out the promise of reducing long-term disparities in outcomes through weight loss, other lifestyle modification, and the timely initiation of medical treatment.”

There could, however, be reservations about this new recommendation as we still don’t know the full impact of increased diagnosis and treatment in the screening of asymptomatic individuals aged 35-40. As Grant and his co-authors add, “evidence-based strategies have been challenging to implement in clinical practice owing to barriers such as the intense resources required, limitations on reimbursement, and out-of-pocket costs to patients. If young adults newly identified with abnormal glucose metabolism do not receive the needed intensive behavioral change support, screening may provide no benefit.”

Finally, most private insurance plans are required to cover preventive services that receive a grade of A or B from the USPSTF without a copay, but coverage and costs are not considered in assigning grades to preventative services.

Conclusion

At Lark, we focus heavily on prevention. With AI-powered programs like Diabetes Prevention (DPP), we aim to build lifelong healthy habits through Cognitive Behavioral Therapy-based coaching conversations to help manage and lower the risk of developing type 2 diabetes. In fact, a study in the New England Journal of Medicine found that participants in a DPP can lower their risk of developing diabetes over the next three years by 58% just with lifestyle changes.

The later a condition like prediabetes or diabetes is diagnosed, the more expensive the care is in the long run, which many, unfortunately, can't afford. This includes high costs associated with copays, large deductibles, medications including insulin, and even additional social factors that are often overlooked such as childcare and transportation. 

We believe DPPs can lead to primary prevention benefits for this lower 35-39 age group. We look forward to forthcoming studies on the impact of this change in guidance. Regardless, we hope to see improvements in health outcomes and lower healthcare costs because DPPs, especially digital ones, have proven to not only yield positive outcomes but also proven to be cost-effective. If you have any thoughts you’d like to share regarding this new USPSTF recommendation, we’d love to hear from you at modernizecare@lark.com

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