Clinical performance and health equity implications of the American Diabetes Association's 2023 screening recommendation for prediabetes and diabetes.
Level 3 - non-randomized controlled study
Cross-sectional diagnostic accuracy study using nationally representative survey data (NHANES).
PubMed 37900145 · doi:10.3389/fendo.2023.1279348
What was done
Researchers evaluated the diagnostic performance of the 2023 American Diabetes Association (ADA) prediabetes and diabetes screening guidelines across sex, racial, and ethnic subgroups. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2015–March 2020), they analyzed 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility (based on age, measured BMI, and diabetes risk factors) was compared against laboratory-defined dysglycemia (fasting plasma glucose ≥100 mg/dL or HbA1c ≥5.7%) to calculate sensitivity, specificity, and predictive values.
What was found
An estimated 83.1% (95% CI: 81.2–84.7%) of US adults met criteria for screening. Overall, the ADA screening criteria demonstrated 95.0% sensitivity (95% CI: 92.7–96.6%) and 27.1% specificity (95% CI: 24.5–29.9%). Sensitivity was higher in women (97.8%, 95% CI: 96.6–98.6%) than in men (92.4%, 95% CI: 88.3–95.1%). Among men, racial and ethnic differences were statistically significant for sensitivity (P = 0.04) and specificity (P = 0.02), whereas guideline performance did not differ by race and ethnicity among women.
Why it matters
The 2023 ADA guidelines capture the vast majority of adults with dysglycemia with minimal racial or ethnic disparity, but the very low specificity requires screening over 80% of the adult population.
Limits
The study is cross-sectional and relies on single-timepoint laboratory measurements rather than repeat confirmatory clinical testing. The abstract does not report positive or negative predictive values and does not evaluate clinical outcomes or cost-effectiveness of widespread screening.
Cited by
- supports A higher percentage of men have pre-diabetes than women do in the United States.