October 23, 2014

Another Questionable One-Size-Fits-All Pronouncement

Fortunately, there is still time to comment about this – until November 3, but this draft proposal is typical of their actions and they seldom back down or change little from the draft. Granted, they need to start someplace, but they need some flexibility in their pronouncements.

The draft statement by the US Preventive Services Task Force (USPSTF) says that the new focus is on identifying people with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). This is according to task force member Michael P. Pignone, MD, professor, department of medicine, and chief, division of general internal medicine, at the University of North Carolina, Chapel Hill, NC.

Since the USPSTF is a prevention and screening task force, I had to ask the doctors how they reacted to the Medscape article. They did agree that there needs to be some variables spelled out, but they could live with it.

The recommendation calls for screening everyone beginning at age 45 years, as well as younger adults with risk factors including overweight or obesity, a first-degree relative with diabetes, women with a history of gestational diabetes or polycystic ovarian syndrome, and certain racial/ethnic minority groups. This includes African Americans, American Indians/Alaskan Natives, Asian Americans, Hispanics/Latinos, and Native Hawaiians/Pacific Islanders.

The task force spokesman says that the proposed recommendations are generally in line with diabetes screening recommendations previously made by other groups, including the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists, the American Academy of Family Physicians, Diabetes Australia, Diabetes UK, and the Canadian Task Force on Preventive Health Care.

Both doctors felt good about some of it, but emphasized that they gave family history more importance than obesity, and felt that testing should be done earlier for women that had gestational diabetes. Both doctors agreed with this statement - Part of the task force's intent is to get physicians to think about lifestyle intervention more, and it's also a call to make effective lifestyle programs more available. They said this was important to make all doctors more aware and focus on this more.

I asked if they felt Medicare would allow this and reimburse doctors for the time. Both felt this would be the barrier and prevent this from becoming a reality. They also agreed that a major issue is how to follow up with those who screen positively. The felt that the cost of screening itself is quite inexpensive, but we have to think of the full spectrum of care that's required. Apart from cost, it's going to be hard to deliver good lifestyle-intervention programs to the large number of US adults who might benefit from them.

I appreciate my conversation via email about their perspectives and respect their putting me in a better mood

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