Diabetes is a global epidemic that has many countries, including the United States, focused on developing better treatment and prevention strategies. In 2015, the United States Preventive Services Task Force (USPSTF), a government supported group of independent medical experts, issued a new recommendation: Overweight or obese adults between the ages of 40 and 70 should be screened for prediabetes and diabetes.
Matthew O’Brien, Assistant Professor of Medicine at Northwestern University’s Feinberg School of Medicine, works as a physician in underserved communities. When the USPSTF announced its recommendation last October, he began to question whether this screening program would help the communities he serves. O’Brien teamed up with his colleagues to gauge the effectiveness of the screening recommendation by analyzing the electronic health records of over 50,000 adults.
The results of the study, published in PLOS Medicine, found that the USPSTF’s screening criteria may only identify half of adults with undiagnosed diabetes or prediabetes; this detection rate drops for racial or ethnic minorities, compared to whites. To learn more about this research, I asked O’Brien to tell us about himself and his recent study via email.
When did you become interested in studying community-based health, and why diabetes research?
MOB: I began working in community health in 1999 while I was a first-year medical student in Providence, Rhode Island. I was a regular volunteer at a free clinic there, which has since grown to be a large community health center like the ones we studied in our PLOS paper. During my medical residency in Philadelphia, I worked with a group of colleagues to start a community health center that serves a large Latino population there. My interest in community health for underserved populations led me to diabetes, which is a disease that disproportionately impacts racial/ethnic minorities and those with socioeconomic disadvantages.
A lot of research is done on diabetes prevention and treatment. Why did you decide to conduct a retrospective analysis on the USPSTF screening recommendation?
MOB: For the last five years, I have been conducting intervention research to prevent diabetes in Latinos using an evidence-based lifestyle program focused on healthy eating and physical activity. Through this work, and epidemiologic studies conducted by our group and others, we have seen a trend toward increasing diabetes risk at younger ages among Latinos. When the USPSTF diabetes screening recommendation was released, I immediately wondered whether it would miss Latinos who are developing prediabetes and diabetes before the age of 40. In addition, as a primary care doctor who cares for a diverse patient population, I had a general interest to see how this recommendation might apply to all of my patients.
The patients you analyzed were from six large community health centers in the Midwest and Southwest. Why did you choose to study these areas, and do you think you would find the same results if you studied other parts of the country?
MOB: We chose 6 large community health centers in the Midwest and Southwest as the sites for our study because they serve a high proportion of racial/ethnic minorities and share an electronic health record that allowed us to examine a large number of patients. These centers have participated in similar studies before and were therefore excited to address this research question, which is central to their mission given the large burden of diabetes seen in their clinics. The characteristics of patients we studied were similar to those reported from all federally-funded community health centers nationally, which collectively serve over 15 million adults. Therefore, we expect that the results would be similar if we conducted the study in other community health centers located in other parts of the country.
One of your findings suggests that the USPSTF screening criteria may miss a large percentage of racial and ethnic minority patients. What did your study find specifically, and did you expect the results?
MOB: Specifically, we found that racial/ethnic minorities who developed prediabetes and diabetes were less likely to be identified by the USPSTF screening recommendation than whites. This means that a diagnosis of prediabetes or diabetes could be delayed in these groups, who already have higher rates of diabetes and related complications than whites. Before conducting the study, we hypothesized that this might be the case because minorities are more likely than whites to develop diabetes at younger ages (Latinos, African Americans, and Native Americans) and normal weights (primarily Asians). Because the USPSTF screening recommendation focuses on adults who are 40-70 years old and overweight or obese, we were concerned that these groups may be missed by the criteria.
How does your study further this area of research, and what are your next steps?
MOB: Other expert groups have advocated for diabetes screening based on a larger number of risk factors, including non-white race/ethnicity. Our study, which is the first to examine the 2015 USPSTF screening recommendation, supports the practice of screening racial/ethnic minorities earlier. However, patients may have to pay for screening tests out-of-pocket if they do not fall within the age and weight-based criteria recommended by the USPSTF. In terms of next steps, we are currently replicating this same analysis in a nationally-representative population of U.S. adults to see if we reach the same findings. We are also planning future research in the same six community health centers to promote diabetes screening and provide evidence-based care to prevent and treat diabetes among those with a positive screening test.
Research Article: O’Brien MJ, Lee JY, Carnethon MR, Ackermann RT, Vargas MC, Hamilton A, et al. (2016) Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med 13(7): e1002074. doi:10.1371/journal.pmed.1002074
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