Are U.S. Preventive Services Task Force Recommendations Effective? An Evaluation of the 2015 Prediabetes/Diabetes Recommendation.

Abstract

Glucose screening is widely recommended to prevent diabetes, but prediabetes screening and treatment remain suboptimal. This study aimed to assess changes in the proportions and odds of diagnosed and undiagnosed prediabetes and diabetes before and after the 2015 U.S. Preventive Services Task Force (USPSTF) screening recommendation. This cross-sectional study used National Health and Nutrition Examination Survey data from 2011 to 2014 (before recommendation) and 2017 to 2023 (after recommendation). Analyses used chi-square tests and logistic regression. Stratified analyses by poverty and insurance status examined the role of access to care. All analyses were survey weighted and provide nationally representative estimates for the U.S. adult population. After the 2015 USPSTF recommendation, among individuals with prediabetes, the proportion with diagnosed prediabetes increased significantly from 28.2% to 43.6% (p<0.0001). Greater increases were observed among individuals experiencing poverty or without insurance in both groups. The odds of diagnosed prediabetes were higher (OR=2.0; 95% CI=1.6, 2.4), with the largest effect among the uninsured (OR=3.8; 95% CI=2.5, 5.9). No significant increase in the proportion or odds of diagnosed diabetes was observed overall or in any subgroup. The 2015 USPSTF recommendation on prediabetes/diabetes screening was associated with a reduced proportion of adults with undiagnosed prediabetes. This effect was even greater for patients experiencing poverty or without health insurance. There was no impact on the proportion of undiagnosed diabetes, which may be due to a ceiling effect. Some of the mechanisms used to incentivize prevention are still under debate. Prevention of disease should continue to be a focus for the U.S. healthcare system.