The French have a lower rate of type 2 diabetes than do Americans, in part because, on average, they eat less overall and tend to consume a diet with lots of fish, grains, nuts, and produce, and modest amounts of alcohol.
That's a matter of debate. The American College of Endocrinologists endorses widespread screening, including people under age 45 who are overweight. But the U.S. Preventive Services Task Force, an independent advisory group to the government, says it should be limited to people with symptoms or those over age 45 who have high blood pressure or cholesterol levels.
Our take
We recommend a middle ground: testing overweight people under age 45 if they have symptoms or one or more additional risk factors, notably high blood pressure, cholesterol, or trigylceride levels, a family history of diabetes or a personal history of gestational diabetes or heart disease, or people of a non-Caucasian heritage. And everyone 45 and over should be tested every three years, regardless of his or her risk level.
What's the best test?
The gold standard is the oral glucose tolerance test, in which patients drink a sugar solution and have their blood sugar checked several times over the next two hours. But nearly as good and faster is a blood sugar check after an overnight fast. Another test, the hemoglobin A1c (HbA1c), reflects the average blood sugar level over the prior three months. Though most doctors use it to monitor diabetes, some also use it for screening.
Our take
The fasting glucose test makes most sense because it's easiest and cheapest. The HbAIc test should be done every 3 to 6 months to monitor diabetes treatment.
