Chapter 4: Endocrine and Metabolic Disorders

DIABETES MELLITUS (DM), TYPE 2

Population

• –Adults.

Recommendation

USPSTF 2015

• –Screen as part of cardiovascular risk assessment if age 40–70 y and BMI >25.

Source

• –USPSTF. Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. 2015.

Comment

1. Screen at least every 3 y in asymptomatic adults.

OBESITY

Population

• –Adults age >18 y.

Recommendation

AAFP 2012, USPSTF 2012

• –Screen all adults and offer intensive counseling and behavioral interventions to promote sustained weight loss in obese adults with BMI ≥30 kg/m².

Source

• –USPSTF. Obesity in Adults: Screening and Management. 2012.

Comment

1. Intensive counseling involves more than one session per month for at least 3 mo.

Recommendations

VA/DoD 2014

• –Measure height, weight, and BMI at least annually.

• –Consider annual measurement of waist circumference.

Source

• –VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, Version 2.0. 2014.

Comment

1. Offer intensive intervention to promote weight loss to

   1. Obese adults (BMI ≥30 or waist circumference ≥40 in. [men] or ≥35 in. [women]).

   2. Overweight adults (BMI 25–29.9) with an obesity-associated condition.^a

THYROID CANCER

Population

• –Asymptomatic persons.

Recommendations

USPSTF 2017

• –Do not screen asymptomatic people with ultrasound.

• –Be aware of higher-risk patients: radiation administered in infancy and childhood for benign conditions (thymus enlargement, acne), which results in an increased risk beginning 5 y after radiation and continuing until >20 y later; nuclear fallout exposure; history of goiter; family history of thyroid disease; female gender; Asian race. (Int J Cancer. 2001;93:745) (N Engl J Med. 2015;373:2347) (N Engl J Med. 2012; 367:705)

Sources

• –JAMA. 2017;317(18):1882-1887.

• –http://www.aafp.org/online/en/home/clinical/exam.html

• –http://www.cancer.org

Comments

1. Neck palpation for nodules in asymptomatic individuals has sensitivity of 15%–38% and specificity of 93%–100%. Only a small proportion of nodular thyroid glands are neoplastic, resulting in a high false-positive rate.

2. Fine-needle aspiration (FNA) is the procedure of choice for evaluation of thyroid nodules. (Otolaryngol Clin North Am. 2010;43:229-238)

THYROID DYSFUNCTION

Population

• –Adults.

Recommendations

AAFP 2015, USPSTF 2015

• –Insufficient evidence to recommend for or against routine screening for thyroid ...