Diabetes Screening: Which Patients, What Tests, and How Often?
McCarron, Robert M., Current Psychiatry
Psychiatric patients--especially those with schizophrenia or taking atypical antipsychotics--are at risk for developing type 2 diabetes mellitus (T2DM) and prediabetes conditions. T2DM can be present for years without significant symptoms and even asymptomatic conditions increase the risk of cardiovascular, renal, retinal, and neurologic complications.
Despite a need for T2DM screening and treatment, expert guidelines disagree on who and how to screen (Table 1, page 20). Although testing patients who have diabetes symptoms--including polyuria, polydipsia, and weight loss--is indicated, some medical groups advocate screening asymptomatic persons for T2DM.
Table 1 General population screening recommendations for type 2 diabetes mellitus or prediabetes Organization Year Whom to How to screen screen U.S. Preventive Services Task Force 2008 Asymptomatic FPG or OGTT (USPSTF) adults with every 3 sustained years blood pressure > 135/80 mmHg (treated or untreated) American Diabetes Association 2009 All adults FPG or (ADA) age [greater 2-hour OGTT than or equal every 3 to]45 Adults years or of any age more with BMI >25 frequently, kg/[m.sup.2] depending on and [greater initial than or equal results and to] 1 risk risks factors for diabetes (Table 2, page 23) American Association of Clinical 2007 All adults FPG or Endocrinologists (AACE) age [greater 2-hour OGTT than or equal (frequency to]30 with not risk factors specified) for diabetes (Table 2, page 23) European Association for the Study 2007 All adults OGTT of Diabetes (EASD) and European with elevated (frequency Society of Cardiology (ESC) risk score * not indicated) FPG: fasting plasma glucose; OGTT: oral glucose tolerance test (75 gm glucose load); BMI: body mass index * Risk scoring tool available at www.diabetes.fi/english/risktest
Consensus guidelines. In 2004, the American Diabetes Association (ADA), American Psychiatric Association (APA), American Association of Clinical Endocrinologists (AACE), and North American Association for the Study of Obesity (NAASO) created consensus guidelines for screening psychiatric patients receiving atypical antipsychotics. In addition to diabetes risk, psychiatric patients are at higher risk for metabolic syndrome, dyslipidemia, obesity, and hypertension. (1). The ADA, APA, AACE, and NAASO recommend regularly screening for weight gain and dyslipidemia, obtaining baseline values of fasting plasma glucose (FPG), rechecking FPG after 3 months, and then screening annually for diabetes or prediabetes. …