We reviewed the Canadian Task Force on Preventive Health Care’s (CTFPHC) guidelines,1 in which the authors recommend Canadian adults undergo preliminary screening for type 2 diabetes using a standardized risk calculator, followed by risk stratification to hemoglobin A1C testing. We have several concerns regarding this approach to screening.
Consider that a 20-year-old obese First Nations female who does not consume fruits or vegetables, does not exercise, does not take antihypertensives, has no documented dysglycemia, but has 1 parent with type 2 diabetes would have a cumulative score of 14 using the CTFPHC’s recommended risk calculator. A score of 14, as per the guidelines, does not support screening for type 2 diabetes. Our clinical experience in Manitoba and northwestern Ontario has shown us that based on her clinical characteristics, including her ethnicity, this woman is at high risk for developing type 2 diabetes and should be screened.
In Manitoba, the incidence of type 2 diabetes in children under 19 years of age is the highest in Canada,2,3 surpassing the provincial pediatric incidence of type 1 diabetes.4 The Canadian Diabetes Association recommends annual screening in children 10 years of age and older who have high-risk characteristics, including Aboriginal heritage.5 The current screening recommendations have the potential to create confusion among health professionals and to send mixed messages to patients, families and communities. Most important the recommendations could delay diagnosis of type 2 diabetes in high-risk populations. We feel it necessary to challenge the recommendations and to urge the CTFPHC to consider screening protocols more generalizable to the diverse ethnic groups and changing demographics of type 2 diabetes in younger populations in Canada.