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Cited by 97Health Promotion and Cardiovascular PreventionDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Screening for Prediabetes and Type 2 Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

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Jonas, Daniel E., Crotty, Karen, Yun, Jonathan D. Y., Middleton, Jennifer Cook, Feltner, Cynthia, Taylor-Phillips, Sian, Barclay, Colleen, Dotson, Andrea +4 more·2021·JAMA
DOI 10.1001/jama.2021.10403
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Abstract

Importance: Type 2 diabetes is common and is a leading cause of morbidity and disability. Objective: To review the evidence on screening for prediabetes and diabetes to inform the US Preventive Services Task Force (USPSTF). Data Sources: PubMed/MEDLINE, Cochrane Library, and trial registries through September 2019; references; and experts; literature surveillance through May 21, 2021. Study Selection: English-language controlled studies evaluating screening or interventions for prediabetes or diabetes that was screen detected or recently diagnosed. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when at least 3 similar studies were available. Main Outcomes and Measures: Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms. Results: The review included 89 publications (N = 68 882). Two randomized clinical trials (RCTs) (25 120 participants) found no significant difference between screening and control groups for all-cause or cause-specific mortality at 10 years. For harms (eg, anxiety or worry), the trials reported no significant differences between screening and control groups. For recently diagnosed (not screen-detected) diabetes, 5 RCTs (5138 participants) were included. In the UK Prospective Diabetes Study, health outcomes were improved with intensive glucose control with sulfonylureas or insulin. For example, for all-cause mortality the relative risk (RR) was 0.87 (95% CI, 0.79 to 0.96) over 20 years (10-year posttrial assessment). For overweight persons, intensive glucose control with metformin improved health outcomes at the 10-year follow-up (eg, all-cause mortality: RR, 0.64 [95% CI, 0.45 to 0.91]), and benefits were maintained longer term. Lifestyle interventions (most involving >360 minutes) for obese or overweight persons with prediabetes were associated with reductions in the incidence of diabetes (23 RCTs; pooled RR, 0.78 [95% CI, 0.69 to 0.88]). Lifestyle interventions were also associated with improved intermediate outcomes, such as reduced weight, body mass index, systolic blood pressure, and diastolic blood pressure (pooled weighted mean difference, -1.7 mm Hg [95% CI, -2.6 to -0.8] and -1.2 mm Hg [95% CI, -2.0 to -0.4], respectively). Metformin was associated with a significant reduction in diabetes incidence (pooled RR, 0.73 [95% CI, 0.64 to 0.83]) and reduction in weight and body mass index. Conclusions and Relevance: Trials of screening for diabetes found no significant mortality benefit but had insufficient data to assess other health outcomes; evidence on harms of screening was limited. For persons with recently diagnosed (not screen-detected) diabetes, interventions improved health outcomes; for obese or overweight persons with prediabetes, interventions were associated with reduced incidence of diabetes and improvement in other intermediate outcomes.

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  • The most recent US Preventive Services Task Force Recommendation Statement and updated Evidence Review have added metformin among diabetes prevention interventions.

    “The most recent US Preventive Services Task Force Recommendation Statement and updated Evidence Review have added metformin among diabetes prevention interventions. 13,17,18”

    From Metformin Prescription Rates for Patients with Prediabetes (2022) · cites this paper as [18]

    The Discussion reports that the updated evidence review assessed metformin for prediabetes and found it associated with reduced diabetes incidence. The introductory passage describes the earlier USPSTF recommendation, but this paper does not establish that the updated Recommendation Statement added metformin as a recommended intervention. (LLM, conf=0.84)

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  • In countries with universal health insurance and good access to primary care, people at high risk of diabetes might be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.

    “In countries with universal health insurance and good access to primary care, people at a high risk of diabetes might also be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.48–55”

    From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [55]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Diet and lifestyle modification and medicines in people at high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.

    “Alongside these population-based measures, diet and lifestyle modification and medicines in people at a high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.48–55”

    From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [55]

    Key Question 7a reports that lifestyle interventions and several medicines reduced diabetes incidence in people with prediabetes. The Benefits of Interventions for Type 2 Diabetes and Prediabetes section reports lower cardiovascular-related mortality after long-term follow-up in one lifestyle-intervention trial, but says most trials were too short to assess effects on health outcomes. It does not establish that medicines reduce the risk of complications in this group. (LLM, conf=0.84)

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Research works printed but not linked: 1

  1. Jonas D, Crotty K, Yun JD, et al. Screening for Prediabetes and Type 2 Diabetes Mellitus: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 207. Agency for Healthcare Research and Quality; 2021. AHRQ publication 21-05276-EF-1.

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Authors
Jonas, D. E., Crotty, K., Yun, J. D. Y., Middleton, J. C., Feltner, C., Taylor-Phillips, S., Barclay, C., Dotson, A., Baker, C., Balio, C. P., Voisin, C. E., & Harris, R. P.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • MaineGeneral Medical Center (US)
  • Warwick Medical School, University of Warwick, Coventry, West Midlands, United Kingdom
Corresponding author
Jonas, Daniel E.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2021-08-24
Volume
326
Issue
8
Pages
744
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2021.10403
OpenAlex
W3193302189
Cited by
96
References
115
Citations by year
2026: 15 · 2025: 15 · 2024: 23 · 2023: 21 · 2022: 13 · 2021: 9
FWCI
2.94
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health and Care Research (CDF-2016-09-018)
  • Agency for Healthcare Research and Quality
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
prediabetes, type 2 diabetes, diabetes screening, tight glycemic control, metformin, sulfonylureas, insulin therapy, lifestyle intervention, cardiovascular risk reduction, all-cause mortality, cardiovascular morbidity, diabetes prevention, screening harms, overweight and obesity, USPSTF recommendations, UK Prospective Diabetes Study, UKPDS
MeSH terms
Adult, Aged, Cause of Death, Diabetes Mellitus, Type 2, Female, Humans, Male, Mass Screening, Middle Aged, Obesity, Prediabetic State, Risk Reduction Behavior, Overweight

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