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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