Why Diabetes Should be Screened by Age Instead of Weight

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 2023-04-04

Diabetes is screened for based on many different factors. There are no regular screening guidelines for type 1 diabetes, as diagnosis is usually based on the traditional symptoms of diabetes and confirmed with a blood test. 

Gestational diabetes is screened for with a glucose test during pregnancy. For overweight and adults living with obesity between the ages of 35-70, screening for abnormal blood sugar levels (prediabetes) and type 2 diabetes is recommended every three years. 

Individuals over age 40 who are overweight and live with obesity who also have diabetes risk factors, such as a family history of type 2 diabetes or if they’re from higher-risk racial or ethnic backgrounds, should be considered for earlier and more frequent screening. However, that’s not a hard and fast recommendation. 

Does diabetes screening based on body weight alone catch all cases?

These widely accepted recommendations for type 2 diabetes screenings rely solely on body weight. A recent  study from the American Journal of Preventive Medicine argues that many cases of diabetes are missed this way, and suggests that screening should be based on age instead. 

When the researchers looked at data collected from 3,243 non-pregnant adults without diagnosed diabetes, and without the BMI and weight thresholds across all demographics, the results for catching prediabetes and diabetes were much higher in across all demographic groups. 

The study goes on to say that many people, especially people from Asian communities, develop type 2 diabetes at lower weight and lower body mass index (BMI). The percentage of Asian Americans, in particular, that were diagnosed at the younger age was much lower than the general population. 

This means that current guidelines leave many people with undiagnosed prediabetes and type 2 diabetes—taking months and even years before a proper diagnosis could be made. To catch cases of pre diabetes and type 2 diabetes in these communities, researchers suggest that diabetes screenings should occur in all adults ages 35-70 regardless of their weight. 

Changing guidelines could be a win for health equity 

Changing these guidelines would be a huge win for health equity and would reduce biases, including weight bias, in the healthcare system.

This is because Asian, Hispanic, and non-Hispanic Black adults experience abnormal blood sugar levels (prediabetes) and develop type 2 diabetes at both a lower body weight and lower BMI level. 

The United States Preventive Services Task Force updated their diabetes screening guidelines in 2021, lowering the age from 40 to 35. With more Americans are being diagnosed with prediabetes and type 2 diabetes at younger ages, this change was long overdue. However, some improvements could still be made to their recommendations, including doing away with weight and BMI requirements.

The pros and cons of more testing 

Some analysts argue that a con of overtesting the wider population is getting many false-positives (many people without prediabetes or diabetes experience blood sugar spikes after eating), and that it’s another unnecessary test for many people who wouldn’t leave with a diagnosis. 

A 2022 study found that between 1-2% of the U.S. population currently has undiagnosed diabetes, which is between 3-6 million people.

However blood sugar tests are extremely affordable, quick and easy to obtain in a regular doctor’s office. There are few risks to a simple blood sugar check. 

This would not only improve health outcomes for many, but also improve health equity across our healthcare system by shortening time from detection to diagnosis to treatment, vastly improving access to care for underserved communities that face weight biases. 

Physicians, take note 

Even if the current recommendations from the USPSTF are still based on weight alone, doctors can take preventive health measures now and do routine blood sugar screenings for people over the age of 35, regardless of their weight. 

This is especially true for those from marginalized racial and ethnic groups who may develop type 2 diabetes at a lower body weight. 

If you’re concerned that you may be experiencing abnormally high blood sugar levels and want to be tested for prediabetes and diabetes, talk with your doctor about getting screened. 

Symptoms of diabetes include:

  • Extreme thirst
  • Frequent urination
  • Weight loss
  • Fatigue
  • Dry mouth
  • Fruity-smelling breath 

(Click here to download our #SeeTheSigns graphic)

If you are currently experiencing any of these symptoms and think you may have diabetes, contact your doctor or seek emergency medical assistance immediately. 

Undiagnosed diabetes and exceedingly high blood sugar levels can lead to diabetic ketoacidosis (DKA), which is a serious medical condition that could be fatal if not treated promptly. If left untreated for months or years, undiagnosed diabetes runs of risk of serious complications including blindness, heart disease, kidney failure, lower-limb amputations and premature death. 

WRITTEN BY Christine Fallabel, POSTED 04/04/23, UPDATED 04/04/23

Christine Fallabel has been living with type 1 diabetes since 2000. She’s a health and science writer and has been featured in Diabetes Daily Grind, Insulin Nation, Diabetics Doing Things, and is a regular contributor to Diabetes Strong, T1D Exchange and Healthline. She earned her Master of Public Health from Temple University and received her Bachelor of Arts from The University of Delaware. In her spare time, she enjoys hiking with her husband in the mountains of Colorado, tinkering with her DIY Loop insulin pump, drinking strong coffee and reading in front of a cozy fire.



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