Screening for Prediabetes and Diabetes in a National Network of Federally Qualified Health Centers: An Observational Study

Background: In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended screening for prediabetes and diabetes among adults aged 35–70 years with overweight or obesity. Studying dysglycemia screening in federally qualified health centers (FQHCs) that serve vulnerable patient populations is needed to understand health equity implications of this recommendation. Objective: To investigate screening practices among FQHC patients who would be eligible according to the 2021 USPSTF recommendation. Design: Retrospective cohort study analyzing electronic health records from a national network of 282 FQHC sites. Participants: We included 183,329 patients without prior evidence of prediabetes or diabetes, who had ≥ 1 office visit from 2018–2020. Main Measures: Screening eligibility was based on age and measured body mass index (BMI). The primary outcome, screening completion, was ascertained using hemoglobin A1c or fasting plasma glucose results from 2018–2020. Key Results: Among 89,543 patients who would be eligible according to the 2021 USPSTF recommendation, 53,263 (59.5%) were screened. Those who completed screening had higher BMI values than patients who did not (33.0 ± 6.7 kg/m² vs. 31.9 ± 6.2 kg/m², p < 0.001). Adults aged 50–64 years had greater odds of screening completion relative to younger patients (OR 1.13, 95% CI: 1.10–1.17). Patients from racial and ethnic minority groups, as well as those without health insurance, were more likely to complete screening than White patients and insured patients, respectively. Clinical risk factors for diabetes were also associated with dysglycemia screening. Among patients who completed screening, 23,588 (44.3%) had values consistent with prediabetes or diabetes. Conclusions: Over half of FQHC patients who would be eligible according to the 2021 USPSTF recommendation were screened. Screening completion was higher among middle-aged patients, those with greater BMI values, as well as vulnerable groups with a high risk of developing diabetes. Future research should examine adoption of the 2021 USPSTF screening recommendation and its impact on health equity.