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Fast-forward to value Capitalize on the intelligent network to maximize innovation and increase revenue velocity. Architect for simplicity Build a converged, automated and scalable network to future-proof your infrastructure. Build with trust Accelerate your digital journey with a partner dedicated to trust and security. Explore products and solutions.

Converged SDN Transport Simplify your network by converging services on a unified, automated infrastructure. Routed Optical Networking Merge IP and private line services onto a single layer to streamline lifecycle operations. Mass-Scale Networking. Multi-Vendor Orchestration. Cable Access. Optical Networking. Intelligent Peering. Data Center Interconnect and Cloud. Telco Cloud. Neither trial found a reduction in all-cause or type-specific mortality with screening compared with no screening over approximately 10 years of follow-up, which notably may have been too short to detect an effect on health outcomes.

Neither trial found statistically significant differences in cardiovascular events, quality of life, nephropathy, or neuropathy between screening and control groups, but data collection for these outcomes was limited to a minority of trial participants. It found no difference over 5 to 10 years of follow-up between an intensive multifactorial intervention aimed at controlling glucose, blood pressure, and cholesterol levels and routine care in the risk of all-cause mortality, cardiovascular-related mortality, occurrence of a first cardiovascular event, chronic kidney disease, visual impairment, or neuropathy.

Follow-up may have been too short in this trial to detect an effect on the health outcomes of interest. Thirty-eight trials that assessed behavioral or pharmacologic interventions for prediabetes reported on health outcomes.

Follow-up duration in most of these trials may have been too short to detect an effect on health outcomes. One trial, the Da Qing Diabetes Prevention Study comparing a 6-year lifestyle intervention diet, exercise, or both with control, found lower all-cause mortality and CVD-related mortality in the combined intervention groups vs control group at 23 and 30 years of follow-up, though not at 20 years of follow-up all-cause mortality: The UKPDS found that all-cause mortality, diabetes-related mortality, and myocardial infarction were improved with intensive glucose control with sulfonylureas or insulin over 20 years year posttrial assessment but not at shorter follow-up.

Intensive glucose control was associated with a decreased risk for all-cause mortality relative risk [RR], 0. The other 2 studies found no statistically significant difference between intervention and control groups in all-cause mortality and risk of myocardial infarction; however, these studies were limited by short duration of follow-up, small study size, or both.

The Diabetes Education and Self Management for Ongoing and Newly Diagnosed DESMOND trial 39 , 40 found no statistically significant difference in all-cause mortality between persons randomly assigned to group education and those randomly assigned to the control group over 1 and 3 years of follow-up. Quiz Ref ID Twenty-three trials compared lifestyle interventions with a control group for delaying or preventing the onset of type 2 diabetes.

Most of the trials focused on persons with impaired glucose tolerance. Meta-analysis of the 23 trials found that lifestyle interventions were associated with a reduction in progression to diabetes pooled RR, 0. In post hoc analyses, the DPP reported that lifestyle intervention was effective in all subgroups and treatment effects did not differ by age, sex, race and ethnicity, or BMI after 3 years of follow-up.

Several trials also reported the effects of lifestyle interventions on intermediate outcomes. Quiz Ref ID Fifteen trials evaluated pharmacologic interventions to delay or prevent diabetes. Two trials reported the effects of metformin on intermediate outcomes. Some of the trials reporting on the benefits of screening and interventions for prediabetes and type 2 diabetes also reported harms. However, the results suggest possible short-term increases in anxiety at 6 weeks among persons screened and diagnosed with diabetes compared with those screened and not diagnosed with diabetes.

Harms of interventions for screen-detected or recently diagnosed type 2 diabetes were sparsely reported and, when reported, were rare and not significantly different between intervention and control groups across trials. Several trials reported on harms associated with interventions for prediabetes.

Four studies of pharmacotherapy interventions reported on any hypoglycemia and found no difference between interventions and placebo over 8 weeks to 5 years. Three trials found higher rates of gastrointestinal adverse events associated with metformin. Although not reported in studies, lactic acidosis is a rare but potentially serious adverse effect of metformin, primarily in persons with significant renal impairment.

In response to public comment, the USPSTF clarified that disparities in the prevalence of prediabetes and type 2 diabetes are due to social factors and not biological ones, and incorporated person-first language when referring to persons who have overweight or obesity.

Some comments requested broadening the eligibility criteria for screening to all adults, or to persons with any risk factor for diabetes, and not confined to persons who have overweight or obesity.

The USPSTF appreciates these perspectives; however, the available evidence best supports screening starting at age 35 years. The USPSTF also added language clarifying that overweight and obesity are the strongest risk factors for developing prediabetes and type 2 diabetes. More studies are needed on the effects of screening on health outcomes that enroll populations reflective of the prevalence of diabetes in the US, particularly racial and ethnic groups that have a higher prevalence of diabetes than White persons.

More US data are needed on the effects of lifestyle interventions and medical treatments for screen-detected prediabetes and diabetes on health outcomes over a longer follow-up period, particularly in populations reflective of the prevalence of diabetes.

More research is needed on how best to increase uptake of lifestyle interventions, especially among populations at highest risk for progression to diabetes and adverse health outcomes. Clinical trials and additional modeling studies are needed to better elucidate the optimal frequency of screening and the age at which to start and stop screening. More research is needed on the natural history of prediabetes, including the identification of factors associated with risk of progression to diabetes or reversion to normoglycemia.

If the results are normal, it recommends repeat screening at a minimum of 3-year intervals. The American Association of Clinical Endocrinology 49 recommends universal screening for prediabetes and diabetes for all adults 45 years or older, regardless of risk factors, and screening persons with risk factors for diabetes regardless of age. Testing for prediabetes and diabetes can be done using a fasting plasma glucose level, 2-hour plasma glucose level during a g oral glucose tolerance test, or HbA 1c level.

It recommends repeat screening every 3 years. Corresponding Author: Karina W. Correction: This article was corrected on October 26, , to fix an unclear diagnostic testing standard in the Practice Considerations section. Barry, MD; Carol M. Wong, MD. Author Contributions: Dr Davidson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance.

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