American Diabetes Association Screening

Screening in Adults
  • Screen at age 45 then every 3 years
  • Screen if BMI ≥ 25 and 1 additional risk factor
    – Physical inactivity
    – Family history of diabetes (esp. in 1st degree relative)
    – High risk ethnic population
    – Previous Gestational Diabetes or baby > 9 lbs
    – Hypertension
    – History of vascular disease
    – Dyslipidemia (HDL < 35 / triglycerides > 250)
    – History of impaired glucose tolerance
    – Clinical conditions associated with diabetes acanthosis nigricans
    – PCOS (polycystic ovarian syndrome)
Screening in Children*
  • Every 2 years at age 10 or puberty if:
    • BMI or weight > 85% ( > 120% of ideal)*
    • 2 of the following risk factors:
      • Family history 1st or 2nd degree relative
      • High risk ethnic/racial group
      • Signs or symptoms of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian disease)
Screening for Comoribid Conditions
  • Blood pressure: Every visit
  • Lipids: yearly (every other year if well controlled)
  • Screen for hypothyroidism as it can contribute to dyslipidemia*
  • Screen for tobacco use
  • Screen for depression (more prevalent in patients with chronic disease)
  • In type 1, screen for hypothyroidism and celiac disease
Screening for Complications
  • Dilated eye exam: Yearly
  • Urine microalbumin/creatinine ratio: Yearly
  • Foot screening to prevent amputation:
    – Monofilament, pulses, vibratory: Yearly
    – Visual inspection of feet at every visit
  • Ask about autonomic neuropathies: Erectile dysfunction, postural hypotension, gastroparesis (best test is gastric emptying time*)
  • Screening for cardiac disease with stress echo/thallium if patient is symptomatic, develops microalbuminuria, or for high index of suspicion