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Diabetes Mellitus Title Population Recommendation Screening for Type 2 Diabetes Mellitus in Adults Asymptomatic adults with sustained blood pressure greater than 135/80 mm Hg Screen for type 2 diabetes mellitus. Grade: B Asymptomatic adults with sustained blood pressure 135/80 mm Hg or lower No recommendation. Grade: I (Insufficient Evidence) Risk Assessment These recommendations apply to adults with no symptoms of type 2 diabetes mellitus or evidence of possible complications of diabetes. Blood pressure measurement is an important predictor of cardiovascular complications in people with type 2 diabetes mellitus. The first step in applying this recommendation should be measurement of blood pressure (BP). Adults with treated or untreated BP >135/80 mm Hg should be screened for diabetes. 28 Screening Tests Three tests have been used to screen for diabetes: ●● ●● ●● Fasting plasma glucose (FPG). 2-hour postload plasma. Hemoglobin A1c. The American Diabetes Association (ADA) recommends screening with FPG, defines diabetes as FPG ≥ 126 mg/dL, and recommends confirmation with a repeated screening test on a separate day. Screening Intervals Suggestions for practice regarding insufficient evidence Other relevant information from the USPSTF and the Community Preventive Services Task Force The optimal screening interval is not known. The ADA, on the basis of expert opinion, recommends an interval of every 3 years. When BP is ≤ 135/80 mm Hg, screening may be considered on an individual basis when knowledge of diabetes status would help inform decisions about coronary heart disease (CHD) preventive strategies, including consideration of lipid-lowering agents or aspirin. To determine whether screening would be helpful on an individual basis, information about 10-year CHD risk must be considered. For example, if CHD risk without diabetes was 17% and risk with diabetes was >20%, screening for diabetes would be helpful because diabetes status would determine lipid treatment. In contrast, if risk without diabetes was 10% and risk with diabetes was 15%, screening would not affect the decision to use lipid-lowering treatment. Evidence and USPSTF recommendations regarding blood pressure, diet, physical activity, and obesity are available at http://www.uspreventiveservicestaskforce.org. The reviews and recommendations of the Community Preventive Services Task Force may be found at http://www.thecommunityguide.org. For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.
Falls in Older Adults Title Population Recommendation Prevention of Falls in Community-Dwelling Older Adults Community-dwelling adults aged 65 years and older who are at increased risk for falls Provide intervention consisting of exercise or physical therapy and/or vitamin D supplementation to prevent falls. Grade: B Community-dwelling adults aged 65 years and older Do not automatically perform an in-depth multifactorial risk assessment with comprehensive management of identified risks to prevent falls. Grade: C Risk Assessment Primary care clinicians can consider the following factors to identify older adults at increased risk for falls: a history of falls, a history of mobility problems, and poor performance on the timed Get-Up-and-Go test. 29 Interventions Effective exercise and physical therapy interventions include group classes and at-home physiotherapy strategies and range in intensity from very low (≤9 hours) to high (>75 hours). Benefit from vitamin D supplementation occurs by 12 months; the efficacy of treatment of shorter duration is unknown. The recommended daily allowance for vitamin D is 600 IU for adults aged 51 to 70 years and 800 IU for adults older than 70 years. Comprehensive multifactorial assessment and management interventions include assessment of multiple risk factors for falls and providing medical and social care to address factors identified during the assessment. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, medical comorbid conditions, and patient values. Balance of Benefits and Harms Exercise or physical therapy and vitamin D supplementation have a moderate benefit in preventing falls in older adults. Multifactorial risk assessment with comprehensive management of identified risks has at least a small benefit in preventing falls in older adults. Other Relevant USPSTF Recommendations The USPSTF has made recommendations on screening for osteoporosis. These recommendations are available at http://www.uspreventiveservicestaskforce.org/. For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Page 1 and 2: The Guide to Clinical Preventive Se
Page 3: The Guide to Clinical Preventive Se
Page 7 and 8: Preface The U.S. Preventive Service
Page 9: Selector (ePSS), available via PDA,
Page 12 and 13: Hemochromatosis, Screening.........
Page 15: Preventive Services Recommended by
Page 18 and 19: Section 1: Preventive Services Reco
Page 20 and 21: 4 13 Asymptomatic adults with susta
Page 23 and 24: Abdominal Aortic Aneurysm Title Scr
Page 25 and 26: Aspirin for the Prevention of Cardi
Page 27 and 28: Bacterial Vaginosis in Pregnancy Ti
Page 29 and 30: Bladder Cancer Title Population Rec
Page 31 and 32: Breast Cancer (Preventive Medicatio
Page 33 and 34: Breastfeeding Title Primary Care In
Page 35 and 36: Cervical Cancer Title Screening for
Page 37 and 38: Chronic Kidney Disease Title Popula
Page 39 and 40: Cognitive Impairment Title Populati
Page 41 and 42: Coronary Heart Disease (Risk Assess
Page 43: Depression in Adults Title Populati
Page 47 and 48: Genital Herpes Time Screening for G
Page 49 and 50: Glaucoma Title Population Recommend
Page 51 and 52: Healthful Diet and Physical Activit
Page 53 and 54: Hemochromatosis Title Population Re
Page 55 and 56: Hepatitis C Virus Infection Title S
Page 57 and 58: HIV Infection Title Population Reco
Page 59 and 60: Impaired Visual Acuity in Older Adu
Page 61 and 62: Lipid Disorders in Adults Title Scr
Page 63 and 64: Menopausal Hormone Therapy Title Me
Page 65 and 66: Obesity in Adults Title Population
Page 67 and 68: Osteoporosis Title Screening for Os
Page 69 and 70: Peripheral Artery Disease Title Pop
Page 71 and 72: Sexually Transmitted Infections Tit
Page 73 and 74: Skin Cancer (Screening) Title Scree
Page 75 and 76: Syphilis (Pregnant Women) Title Pop
Page 77 and 78: Tobacco Use in Adults Title Counsel
Page 79: Vitamin Supplementation to Prevent
Page 83 and 84: Blood Lead Levels in Children and P
Page 85 and 86: Congenital Hypothyroidism Title Scr
Page 87 and 88: Gonococcal Ophthalmia Neonatorum Ti
Page 89 and 90: High Blood Pressure (Children) Titl
Page 91 and 92: Illicit and Prescription Drug Use i
Page 93 and 94: Iron Deficiency Anemia (Supplementa
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Major Depressive Disorder in Childr
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Phenylketonuria (PKU) Title Populat
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Speech and Language Delay Title Pop
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Visual Impairment in Children Ages
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Immunizations for Adults and Childr
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Topics in Progress Each USPSTF reco
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Appendixes and Index
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Grade Definitions What the Grades M
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Grade Definitions Prior to May 2007
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David Grossman, M.D., M.P.H. Center
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Appendix C Acknowledgements AHRQ St
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Liaisons to the USPSTF Primary care
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The Task Force does not explicitly
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■■ ■■ Access the Electronic
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Appendix E More Resources AHRQ’s
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Healthy People 2020 Healthy People
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Index 2-hour postload plasma (see D
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Coronary Heart Disease (Risk Assess
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*Illicit and Prescription Drug Use
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Syphilis Infection (Pregnant Women)
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The U.S. Preventive Services Task F
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