In 2021, the US Preventive Services Task Force (USPSTF) expanded the recommended age range for prediabetes and diabetes screening among those with overweight/obesity to 35-70 years. Using 2017 to pre-pandemic March 2020 National Health and Nutrition Examination Survey data, we applied these screening criteria to assess their performance in a nationally representative sample. We included 3243 non-pregnant adults aged ≥18 years without diagnosed diabetes. Screening eligibility was determined based on participants' age and measured body mass index (BMI) [≥23kg/m2 for non-Hispanic (NH) Asian adults and ≥25kg/m2 for other ethnic groups]. Dysglycemia was defined based on A1c ≥5.7% or fasting plasma glucose ≥100mg/dL. We compared participant characteristics by USPSTF eligibility. We also assessed performance [sensitivity, specificity, positive predictive value (PPV) , and negative predictive value (NPV) ] of the screening criteria for detecting dysglycemia overall and by ethnicity. During 2017-2020, 44.4% of US adults aged 35-70 years were eligible for screening, representing 95.9 million US adults. Relative to adults who were ineligible, those who were eligible had a higher burden of diabetes risk factors, as well as greater proportions of some racial ethnic groups, higher proportion of those with less than a high school education, and more likely to be living in poverty. The performance characteristics of the USPSTF screening criteria were: sensitivity 59.4% (95% CI: 56.4-62.4) ; specificity 68.6% (65.1-71.9) ; PPV 62.4% (59.2-65.6) ; and NPV 65.8% (61.9-69.5) . The sensitivity by ethnicity was as follows: NH White adults 59.1% (55.4-62.7) ; NH Black adults 63.6% (57.8-68.9) ; Hispanic adults 62.0% (55.0-68.5) ; and NH Asian adults 57.3% (46.6-67.3) . Screening based on the 2021 USPSTF criteria will detect approximately 60% of US adults with dysglycemia, which was similar across ethnic groups.
M.J.O'brien: None. K.M.Bullard: None. Y.Zhang: n/a. S.Bailey: Consultant; Lundbeck, Luto, Pfizer Inc., Sanofi, Research Support; Eli Lilly and Company, Gordon and Betty Moore Foundation, Lundbeck, Merck & Co., Inc., Pfizer Inc., Retirement Research Foundation for Aging. S.Khan: None. R.T.Ackermann: Consultant; UnitedHealth Group. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. S.R.Benoit: None. G.Imperatore: None. C.S.Holliday: None.