The ADA and AACE just jointly released 2016 screening guidelines for Type 2 Diabetes; they cast a significantly wider net. They now recommend screening everyone over the age of 45. In addition, they are eliminating the term “diabetic” to describe a person living with diabetes. Dr. Linda Girgis, MD, family practitioner, talks about the impact the new guidelines will have on medicine.
In the US, about nine percent of the population (more than 29 million people) are living with diabetes. Of these, approximately 1.25 million have Type 1 Diabetes. For those with Type 2 Diabetes, many are unaware that they have the disease. Researchers estimate over 8 million people have diabetes and do not know it.
Diabetes is more destructive over time. Untreated, it can lead to blindness, kidney failure, heart attacks and other vascular diseases. To prevent these complications, it is imperative it be diagnosed as early as possible.
For years, the guidelines recommended screening patients who had certain risk factors including a family history of someone being diabetic, obesity, concomitant hypertension or hyperlipidedmia, or history of gestational diabetes, or delivering babies weighing over nine pounds.
2016 Screening Guidelines Vastly Widen Screening
However, the ADA (American Diabetes Association) and the AACE (American Association of Clinical Endocrinologists) issued new recommendations for 2016 and are advising universal screening of all adults 45 years of age and older. While the rising incidence of diabetes parallels the upward trends in obesity incidence, many cases are now being diagnosed in people with normal BMIs (Body Mass Index). This is a departure from the recommendations of the past.
The danger with diabetes is many patients are asymptomatic until complications set in. The goal of screening is to detect it early enough to prevent these complications. By screening only high risk individuals, we are still missing many cases of diabetes.
Testing for Diabetes
The most commonly used screening test is a fasting (for eight hours prior) blood glucose test. This is a simple blood test and the results are usually available in 24 hours. Glucose tolerance tests, testing the blood sugar after administering a glucose load of 75 grams, and HbA1C are also used as screening tests. The new guidelines show no preference for which test is administered.
2016 Diabetes Guidelines Updates for Treatment and Prevention
The 2016 guidelines also place emphasis on the management in terms of treatment and prevention of obesity. The Diabetes Prevention Program (DPP) is a federally funded research study of over 3,000 people who are at high risk of diabetes. It showed people who lost five-to-seven percent of their total body weight through healthier eating and exercise could delay or prevent the onset of Type 2 Diabetes. Yet, this advice comes at a time when the obesity epidemic is booming.
In the US, more than 1/3 of adults are obese. In children aged 2-17, obesity is more concerning and now estimated to be around 17 percent. Unless we curb the tide on this obesity tsunami, we are going to see a significant increase of many dangerous, chronic diseases, including diabetes. The new guidelines are right to stress the importance of managing obesity both in treating diabetes and preventing it.
Diabetes, Aspirin, and Women
Another significant change in the 2016 guidelines is the use of aspirin in women with diabetes over the age of 50 years with at least one other risk factor for preventing cardiovascular disease. The previous guidelines recommended this preventative measure only for men. As we witnessed from many sources, cardiovascular disease has been under researched and underestimated in women. The fact that this is included in the most recent guidelines is a huge indication that cardiovascular disease is now being recognized as a major killer in women. The ADA is taking a leadership role for women and cardiovascular disease.
Diabetes Doesn’t Define People, “Diabetics” No Longer Used
In all, the new guidelines consist of 14 sections. Of note, the word “diabetic” will no longer be used in referring to people who have the disease. It will only be used as an adjective in referring to the complications of diabetes. This is in line with their position that diabetes does not define people.
Another significant innovation in the new guidelines is the encouragement to embrace technology, such as apps or texts, to affect lifestyle changes. Additionally, new guidelines were added regarding diabetic kidney disease and retinopathy. Further guidelines address pediatric patients, the elderly, pregnant women, and hospitalized patients. 
The 2016 guidelines are a major step forward in the prevention and treatment of diabetes. It incorporates the latest research findings and takes into consideration new technology. Additionally, it puts the focus back onto the person as a unique individual rather than someone suffering a disease.
In clinical practice, I am seeing diabetes manifesting at younger and younger ages. This is the only failings of the new guidelines in my opinion: not addressing screening in this age group. Hopefully, the next set of guidelines will cover this. As our knowledge of diabetes evolves, the guidelines should continue to do so as well. Patients deserve nothing less.
Dr. Linda Girgis MD, FAAFP is a family physician who treats patients in South River, New Jersey and its surrounding communities. She holds board certification from the American Board of Family Medicine and is affiliated with both St. Peter’s University Hospital and Raritan Bay Hospital. She is an active blogger and active on social media.