Additional Information on USPSTF Pronouncement

On October 21, I received an email from the ADA promoting the US Preventive Services Task Force (USPSTF) pronouncement. While I can agree with much of what they are advocating, I am totally turned off when they label USPSTF as alphabet soup because the acronym is six letters long. To me this means that the ADA is belittling the USPSTF and does not show respect.

Then they use scare tactics by listing the serious complications that diabetes may cause supposedly to show how serious diabetes can be. If the ADA was actually calling for action and supporting the pronouncement of the USPSTF, you would think they could choose a more positive introduction. Diabetes receives enough bad publicity without the ADA adding to this.

Why they use the term Diabetes Advocates to apply to themselves is a puzzle. The email author then says, “This month our years of hard work paid off and the USPSTF recommended – for the first time – that Americans with key risk factors should be tested for diabetes. Studies show that currently more than half of people with undiagnosed diabetes are not tested because they do not meet the current diabetes screening guidelines. Now this will change!”

The author also says this matters because doctors around the country follow USPSTF recommendations. Then the email author says this is vital testing will be completely paid for by a patient's health insurance. Now this is where the two doctors I have been corresponding with have expressed caution. They both agreed that most private insurance companies may pay for the screenings, but will they pay for the follow-up appointments if the tests are positive. Medicare is the other concern as they have been in the habit of not paying.

The doctors do have a large concern about those that fall into the prediabetes range. Without the ADA making this an official classification, they feel this will still be an area that will not be covered, even with a prediabetes diagnosis.

The author of the ADA newsletter declared that the change is critical citing the estimated annual economic cost of undiagnosed diabetes is a staggering $18 billion. With this change, the 10 million Americans with undiagnosed diabetes and the 86 million with prediabetes will have a fighting chance to take action before the devastating complications of diabetes take hold, saving both lives and dollars.

The one thing that makes me hopeful – will the ADA do something about renaming prediabetes and make it an official diabetes designation? One can only hope.

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