{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:55:17Z","timestamp":1772819717773,"version":"3.50.1"},"reference-count":36,"publisher":"American Diabetes Association","issue":"7","license":[{"start":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T00:00:00Z","timestamp":1592524800000},"content-version":"vor","delay-in-days":57,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32-HL-007024"],"award-info":[{"award-number":["T32-HL-007024"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K24-DK-106414"],"award-info":[{"award-number":["K24-DK-106414"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We included 2,236 adults aged \u226565 years without known diabetes from the 2005\u20132016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c \u22656.5%, FPG \u2265126 mg\/dL, or 2-h plasma glucose \u2265200 mg\/dL among those with HbA1c 5.7\u20136.4% or FPG 100\u2013125 mg\/dL); and 2) a standard approach (HbA1c \u22656.5% or FPG \u2265126 mg\/dL). Treatment eligibility was defined using HbA1c cut points (\u22657% to \u22659%). OGTT screening costs were estimated using Medicare fee schedules.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Diabetes prevalence was 15.7% (\u223c5.0 million) using the Endocrine Society\u2019s approach and 7.3% (\u223c2.3 million) using the standard approach. Treatment eligibility ranged from 5.4% to 0.06% and 11.8% to 1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c &amp;lt;6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c\/FPG (\u223c18.3 million) with OGTT could cost between $737 million and $1.7 billion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc19-2467","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:36:17Z","timestamp":1587688577000},"page":"1456-1461","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":14,"title":["Clinical and Public Health Implications of 2019 Endocrine Society Guidelines for Diagnosis of Diabetes in Older Adults"],"prefix":"10.2337","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2849-1780","authenticated-orcid":false,"given":"Michael","family":"Fang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8460-1617","authenticated-orcid":false,"given":"Justin B.","family":"Echouffo-Tcheugui","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6923-7151","authenticated-orcid":false,"given":"Elizabeth","family":"Selvin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1167","published-online":{"date-parts":[[2020,4,23]]},"reference":[{"key":"2022031300280160300_B1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1478-7954-8-29","article-title":"Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence","volume":"8","author":"Boyle","year":"2010","journal-title":"Popul Health Metr"},{"key":"2022031300280160300_B2","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2105\/AJPH.2011.300616","article-title":"Aging, diabetes, and the public health system in the United States","volume":"102","author":"Caspersen","year":"2012","journal-title":"Am J Public Health"},{"key":"2022031300280160300_B3","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1001\/jama.2015.10029","article-title":"Prevalence of and trends in diabetes among adults in the United States, 1988-2012","volume":"314","author":"Menke","year":"2015","journal-title":"JAMA"},{"key":"2022031300280160300_B4","doi-asserted-by":"crossref","first-page":"S139","DOI":"10.2337\/dc19-S012","article-title":"12. 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