The American Diabetes Association, or ADA, recently released its "Standards of Medical Care in Diabetes -- 2008" position statement; the updated standards and supporting materials are available as a supplement to the January issue of Diabetes Care.
The ADA now recommends that physicians consider screening adults of any age who are overweight or obese and have one or more additional risk factors for diabetes; the organization also recommends screening all overweight or obese patients beginning at age 45, even if they have no additional risk factors. The ADA classifies this as a "B" recommendation, which means it is supported by evidence from well-conducted cohort studies or from well-conducted case-control studies.
For all overweight and obese patients, the guidelines recommend repeat screening at intervals of no more than three years. This is a grade "E" recommendation, which means that it is based on expert consensus or clinical experience.
The guidelines also recommend screening women who have had gestational diabetes mellitus for diabetes; this testing should take place six to 12 weeks postpartum and should be followed up with subsequent screening for the development of diabetes or prediabetes (grade E recommendation).
To prevent or delay the development of type 2 diabetes, the ADA recommends counseling patients about losing weight and increasing their physical activity.
For very high-risk patients who are obese and younger that 60, the guidelines recommend that physicians consider prescribing metformin, in addition to lifestyle counseling (grade E recommendation).
They also recommend monitoring any patients who exhibit signs of prediabetes every year (grade E recommendation).
To read more of the new ADA recommendations, go to the American Academy of Family Physicians site
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