Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes

Matthew J. O’Brien; Yan Zhang; Stacy C. Bailey; Sadiya S. Khan; Ronald T. Ackermann; Mohammed K. Ali; Michael E. Bowen; Stephen R. Benoit; Giuseppina Imperatore; Christopher S. Holliday; Kai McKeever Bullard

doi:10.3389/fendo.2023.1279348

Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes

Matthew J. O’Brien^*, Yan Zhang, Stacy C. Bailey, Sadiya S. Khan, Ronald T. Ackermann, Mohammed K. Ali, Michael E. Bowen, Stephen R. Benoit, Giuseppina Imperatore, Christopher S. Holliday, Kai McKeever Bullard

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods: Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results: An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA’s screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion: The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.

Original language	English (US)
Article number	1279348
Journal	Frontiers in Endocrinology
Volume	14
DOIs	https://doi.org/10.3389/fendo.2023.1279348
State	Published - 2023

Funding

SB has received consultant fees from Lundbeck, Luto, Pfizer, and Sanofi. SB has received research support from Eli Lilly, Gordon and Betty Moore Foundation, Lundbeck, Merk, Pfizer, and Retirement Research Foundation for Aging. RA has received consultant fees from UnitedHealth Group. MA has received advisory panel support from Bayer AG and research support from Merk. All potential financial dualities of interest reported here were unrelated to the current study. The authors declare financial support was received for the research, authorship, and/or publication of this article. MO’B and RA’s effort was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK094929). Acknowledgments

Keywords

diabetes screening
health equity
population health
prediabetes screening
racial and ethnic disparities
sex and gender disparities

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fendo.2023.1279348

Cite this

O’Brien, M. J., Zhang, Y., Bailey, S. C., Khan, S. S., Ackermann, R. T., Ali, M. K., Bowen, M. E., Benoit, S. R., Imperatore, G., Holliday, C. S., & McKeever Bullard, K. (2023). Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes. Frontiers in Endocrinology, 14, Article 1279348. https://doi.org/10.3389/fendo.2023.1279348

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abstract = "Introduction: The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods: Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results: An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA{\textquoteright}s screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion: The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.",

keywords = "diabetes screening, health equity, population health, prediabetes screening, racial and ethnic disparities, sex and gender disparities",

author = "O{\textquoteright}Brien, {Matthew J.} and Yan Zhang and Bailey, {Stacy C.} and Khan, {Sadiya S.} and Ackermann, {Ronald T.} and Ali, {Mohammed K.} and Bowen, {Michael E.} and Benoit, {Stephen R.} and Giuseppina Imperatore and Holliday, {Christopher S.} and {McKeever Bullard}, Kai",

note = "Publisher Copyright: Copyright {\textcopyright} 2023 O{\textquoteright}Brien, Zhang, Bailey, Khan, Ackermann, Ali, Bowen, Benoit, Imperatore, Holliday and McKeever Bullard.",

year = "2023",

doi = "10.3389/fendo.2023.1279348",

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O’Brien, MJ, Zhang, Y, Bailey, SC , Khan, SS , Ackermann, RT, Ali, MK, Bowen, ME, Benoit, SR, Imperatore, G, Holliday, CS & McKeever Bullard, K 2023, 'Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes', Frontiers in Endocrinology, vol. 14, 1279348. https://doi.org/10.3389/fendo.2023.1279348

TY - JOUR

T1 - Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes

AU - O’Brien, Matthew J.

AU - Zhang, Yan

AU - Bailey, Stacy C.

AU - Khan, Sadiya S.

AU - Ackermann, Ronald T.

AU - Ali, Mohammed K.

AU - Bowen, Michael E.

AU - Benoit, Stephen R.

AU - Imperatore, Giuseppina

AU - Holliday, Christopher S.

AU - McKeever Bullard, Kai

PY - 2023

Y1 - 2023

N2 - Introduction: The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods: Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results: An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA’s screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion: The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.

AB - Introduction: The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods: Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results: An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA’s screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion: The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.

KW - diabetes screening

KW - health equity

KW - population health

KW - prediabetes screening

KW - racial and ethnic disparities

KW - sex and gender disparities

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Clinical performance and health equity implications of the American Diabetes Association’s 2023 screening recommendation for prediabetes and diabetes

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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