Introduction
Today, master’s-prepared nurses should be ready to help patients by following doctors’ prescriptions, maintaining a treatment plan, cooperating with family members, and educating. However, in addition to the steps taken after the disease is diagnosed, preventive screening guidelines are required in many clinical areas. The awareness of epidemiology allows nurses to understand the causes and progress of a condition and offer interventions to predict complications. In the United States, as well as across the globe, diabetes is a serious chronic disease that affects human life quality and has no cure. According to the Centers for Disease Control and Prevention (CDC, 2020), diabetes is the seventh leading cause of death and a common vision disability cause in 12% of the US population. Regarding the offered sources and knowledge about this condition, nurses must support their patients and encourage screening based on credible guidelines. The US Preventive Services Task Force (USPSTF, 2021) recommends screening for type 2 diabetes and preventive interventions for obese or overweight adults aged 35 to 70. This paper aims to evaluate recommendations, review diabetes epidemiology, and analyze the methods to prove a moderate net benefit of the guideline.
Condition and Screening
Type 2 diabetes is a condition for analysis, and screening tests, like fasting plasma glucose, HbA1C, and an oral glucose tolerance test, for patients of a particular group are recommended. The USPSTF (2021) defines screening for prediabetes and type 2 diabetes as Grade B because there is a high certainty of moderate net benefit. Diabetes is a long-lasting health condition characterized by problems turning food into energy (CDC, 2020). The body does not produce enough insulin because of a poorly working pancreas, and high blood sugar levels stay in the system, provoking heart disease and vision loss. These physiological changes provoke increased thirst, hunger, urination, and fatigue. Although particular groups (Blacks, Asians, and Native Americans) are at a higher risk for diabetes, such factors as age (older adults), physical activity, obesity, sleep quality, and smoking are still critical (Ismail et al., 2021). Recommendations for screening for type 2 diabetes every three years have been changed to underline age and weight characteristics: adults aged between 35 and 70 who are overweight or obese (USPSTF, 2021). Weight risk assessment and glucose measurement are the two reasonable steps for modern populations to consider.
Epidemiology of Condition
Despite the level of obtained knowledge and care quality, it is not always possible to predict diabetes progress in a population. Healthcare providers, researchers, and educators prefer to address recent epidemiological studies. Epidemiology is the study of the determinants and distribution (prevalence) of health conditions in a specific population group (Ahlbom, 2020). There are many statistical terms to include in the epidemiological evaluation of diabetes, and the current project focuses on sex, age, and racial factors. The estimated prevalence of diagnosed diabetes in males is larger than in females: 11% (745,000) and 9.5% (738,000), respectively (CDC, 2020). The number of Americans older than 65 years is higher compared to other age groups, including about 15.9 million seniors (American Diabetes Association [ASA], 2022). Addressing racial differences, the ASA (2022) offers the following numbers: 14.5% of American Indians (the larger trend) and 7.4% of non-Hispanic white (the less trend). In 2019, 87,647 death certificates were reported in the United States and 282,801 certificates globally, with diabetes as an underlying cause (ASA, 2022; CDC, 2020). These numbers cannot be ignored to prove the importance of early symptom detection and prevention.
Methodology
As an independent group of experts in preventing medicine, the USPSTF aims to develop the best methodology processes to maintain the population’s well-being. It consists of five major steps: nominations review, research draft, public comments review, evidence review, and final recommendations (USPSTF, 2021). The same stages are followed in this section of the paper to discuss how to screen and prevent diabetes. Regarding the prevalence of diabetes among adults and insignificant changes in gender differences, it is correct to choose people aged 35-70 years for examination (ASA, 2022; CDC, 2020; Ismail et al., 2021; USPSTF, 2021). One of the first tasks is to inform people from the chosen age group about the risks of diabetes and the necessity of diagnosing this condition at an early stage. However, people usually need more facts to understand the threat, and the recognition of additional factors is required. In this case, obesity is a critical risk factor for diabetes. Ismail et al. (2021) conclude that diabetes risks in elderly people (both men and women) are higher compared to other age statistical groups. Older adults face severe challenges in dealing with diabetes-related complications.
People share common opinions about the importance of managing diabetes to avoid lethal outcomes. They are aware that a healthy lifestyle and dietary habits contribute to diabetes prevention. Still, not many people follow recommendations and neglect physical activities. Ismail et al. (2021) identify physical inactivity as an independent risk factor for type 2 diabetes as it decreases insulin sensitivity and increases beta-cells loss. Considering these findings and the USPSTF guideline, diabetes prevention starts with improving human weight characteristics. Thus, the screening measures based on age and obesity (overweight) in both genders, even if there are no clear symptoms of diabetes, can be proved.
Guideline
There are three main aspects in the USPSTF guideline recommendation: a specific population, the importance of screening, and the development of preventive interventions. The population characteristics are age (35-70 years), Body Mass Index (more than 25 with an exception for Asians – BMI can be more than 25), and race (American Indians, Blacks, Hawaiians, Hispanics, and Asians) (USPSTF, 2021). The screening type includes measuring fasting plasma glucose (HbA1C) level or an oral glucose tolerance test (USPSTF, 2021). The interval obtained among adults would be at least three years, even if the previous blood glucose levels were normal (USPSTF, 2021). Several recommendations are necessary to help asymptomatic individuals understand what changes are reasonable. First, behavioral weight loss allows people to prevent diabetes-related morbidity. Second, smoking cessation is suggested because nicotine reduces muscle glucose intake and promotes insulin resistance (Ismail et al., 2021). Finally, people with diabetes experience fatigue and get tired very quickly. Thus, decreased sleep quality is associated with low oxygen and a high possibility of inflammation. Sleep improvement should not be ignored in preventing diabetes among people of all races, ages, and genders.
Critical Analysis
In recent literature, it is possible to find additional recommendations on how to prevent diabetes and what screening methods are effective for particular population groups. In many developing countries, healthcare providers do not get access to reliable resources to protect people against chronic diseases. For example, in Iran, only half of the diabetic people are aware of their condition, and a new diabetes screening program has been implemented by the Iranian ministry of health (Kianpour et al., 2021). In addition to the age and weight characteristics, local recommendations include a family history of diabetes or gestational diabetes (Kianpour et al., 2021). Patients need to fast for about eight hours before the day they have a diagnostic appointment. If the fast blood glucose test results are higher than 126 mg/dl, additional tests are required to identify the stage of diabetes (Kianpour et al., 2021). Family history plays an important role in identifying diabetes at an early stage, but the USPSTF guideline omits this point in its program.
In comparison, developed countries like Sweden improve their diabetes prevention programs at community and facility levels. According to Timm et al. (2020), such screening methods help cover more unfavorable risk profiles, with special attention to men for achieving a gender balance in interventions. In addition, the Stockholm diabetes program identifies a socioeconomic risk factor and proves its contribution to diabetes progress (Timm et al., 2020). In the United States, the differences in family incomes are mentioned as the determinants of human health. Still, in the USPSTF recommendations, no attention is paid to this population recommendation.
Summary
In general, screening for diabetes is an important step in maintaining human well-being and public health, as it is the only way to identify asymptomatic people who might have this disease. The USPSTF guideline recommendations underline the necessity of taking one of the offered tests and diagnosing if the result is positive. The decision to pay attention to individuals of a particular age range (35-70 years) and a specific physical condition (BMI more than 25) is properly evidenced. There are many risk factors for type 2 diabetes, but obesity and physical inactivity remain the two critical facts that cannot be ignored. Finally, the threat of diabetes continues to grow with age, and older adults may benefit from the offered screening system classified as Grade B and use the offered preventive strategies to improve their health.
References
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American Diabetes Association. (2022). Statistics about diabetes. ADA. Web.
Centers for Disease Control and Prevention. (2020). National diabetes statistics report 2020 estimates of diabetes and its burden in the United States [PDF file]. Web.
Ismail, L., Materwala, H., & Al Kaabi, J. (2021). Association of risk factors with type 2 diabetes: A systematic review. Computational and Structural Biotechnology Journal, 19, 1759-1785. Web.
Kianpour, F., Fararouei, M., Hassanzadeh, J., Mohammadi, M., & Dianatinasab, M. (2021). Performance of diabetes screening tests: An evaluation study of Iranian diabetes screening program. Diabetology & Metabolic Syndrome, 13(1). Web.
Timm, L., Harcke, K., Karlsson, I., Sidney Annerstedt, K., Alvesson, H. M., Stattin, N. S., Forsberg, B. C., Östensond, C. G., & Daivadanam, M. (2020). Early detection of type 2 diabetes in socioeconomically disadvantaged areas in Stockholm – Comparing reach of community and facility-based screening. Global Health Action, 13(1). Web.
US Preventive Services Task Force. (2021). USPSTF recommendations development process. USPSTF. Web.
US Preventive Services Task Force. (2021). Screening for prediabetes and type 2 diabetes: US preventive services task force recommendation statement. JAMA, 326(8), 736-743. Web.