Should I Get Tested for Diabetes? A Simple Decision Guide

You might be wondering if you need a diabetes test. Maybe diabetes runs in your family, or you've been carrying extra weight for a while. Perhaps you have no symptoms at all but wonder if you should still get checked. This decision guide will help you figure out if diabetes screening is right for you.

The truth is, more than half of women with PCOS develop type 2 diabetes by age 40. About 1 in 8 Americans has diabetes, and more than 1 in 4 adults with diabetes don't know they have it. That's why understanding when to get tested matters, especially if you don't have obvious symptoms.

Who Should Consider Diabetes Testing?

Recent guidelines have made it simpler to know when to get tested. The US Preventive Services Task Force (USPSTF) and the American Diabetes Association (ADA) recommend testing for prediabetes and type 2 diabetes at age 35 for certain groups.

But age isn't the only factor. You should consider testing at any age if you have one or more of these risk factors:

• Weight status: Being overweight (BMI 25-29) or obese (BMI 30 or higher)
• Family history: Adults with a family history of diabetes had five times the odds of having diabetes compared with individuals who did not have a family history of diabetes
• Ethnicity: The prevalence of diabetes is higher among American Indian/Alaska Native (14.7%), Asian (9.2%), Hispanic/Latino (12.5%), and non-Hispanic Black (11.7%) persons than among non-Hispanic White (7.5%) persons
• Previous pregnancy complications: History of gestational diabetes
• Other health conditions: High blood pressure, PCOS, or physical inactivity

Understanding Your Family History Risk

Family history is one of the strongest predictors of diabetes risk. But not all family connections carry the same weight.

Having a family history of type 1 diabetes is the highest risk factor for developing the disease: a first-degree relative (parent, sibling, or child) with T1D increases your risk up to 15-fold. However, nearly 85% of diagnoses occur in people who have no family members with the disease.

For type 2 diabetes, the numbers tell a compelling story. If you are a man with type 1 diabetes, the odds of your child developing diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child was born before you were 25, your child's risk is 1 in 25; if your child was born after you turned 25, your child's risk is 1 in 100. Your child's risk is doubled if you developed diabetes before age 11. If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.

The risk increases with the number of affected relatives. The prevalence of diabetes among individuals who have a first-degree relative with diabetes (14.3%) was significantly higher than that of individuals without a family history (3.2%), corresponding to a crude odds ratio of five. Both prevalence and odds ratio estimates significantly increased with the number of relatives affected with diabetes.

Special Considerations for Women with PCOS

If you have polycystic ovary syndrome (PCOS), your risk for diabetes is significantly higher. Women with PCOS are at an increased risk of developing type 2 diabetes and fall into high-risk groups according to the American College of Obstetricians and Gynecologists (ACOG) screening guidelines.

For women with PCOS, the standard screening approach is different. Guidelines further indicate that an oral glucose tolerance test (OGTT) should be used for diabetes screening in women with PCOS instead of an A1C or fasting plasma glucose test. This is because in women with PCOS, fasting glucose failed to recognize glucose intolerance in 58% of cases screened positive by OGTT.

According to the Endocrine Society and the Androgen Excess and Polycystic Ovary Syndrome Society, patients with PCOS should undergo screening with an oral glucose tolerance test (OGTT) every 1 to 2 years.

Which Test Should You Get?

There are three main tests used to screen for diabetes, and each has its advantages:

A1C Test
The A1C test measures your average blood sugar over the past 2-3 months. It is expressed as a percentage, with values below 5.7% considered normal, 5.7% to 6.4% indicating prediabetes, and 6.5% or higher suggesting diabetes. The big advantage? You don't need to fast before taking it.

Fasting Glucose Test
A fasting glucose test measures your blood sugar after not eating for at least 8 hours. Values between 100 to 125 mg/dL indicate prediabetes, and levels of 126 mg/dL or higher suggest diabetes.

Insulin Test
An insulin test can detect insulin resistance before blood sugar rises. Fasting insulin levels could identify insulin resistance long before plasma glucose and HbA1c levels rise. This makes it particularly useful for early detection.

Many doctors now recommend a comprehensive diabetes panel that includes multiple tests for a complete picture of your metabolic health.

Decision Tree: Should You Get Tested?

Here's a simple way to determine if you should get tested:

Get tested now if:

• You're 35 or older AND overweight or obese
• You have PCOS (regardless of age)
• You have symptoms like excessive thirst, frequent urination, or unexplained weight loss
• You had gestational diabetes during pregnancy
• You have a parent, sibling, or child with diabetes

Consider testing if:

• You're under 35 but have multiple risk factors
• You're from a high-risk ethnic group (African American, Latino, Native American, Asian American, Pacific Islander)
• You have high blood pressure or take blood pressure medication
• You're physically inactive most days

Regular screening might not be necessary if:

• You're under 35 with no risk factors
• You maintain a healthy weight
• You have no family history of diabetes
• You're physically active regularly

When to Test Without Symptoms

Some people will not have any symptoms but may have risk factors for type 2 diabetes and need to be tested. Being screened means getting tested when you don't have any symptoms. Catching prediabetes early can help people prevent or delay type 2 diabetes. Finding out they have type 2 diabetes: and taking action: can help people prevent or delay serious health complications.

Even without symptoms, testing is important because:

• There are no clear symptoms of prediabetes, so you may have it and not know it
• Early detection allows for lifestyle changes that can prevent progression to diabetes
• Undiagnosed diabetes can lead to complications affecting your heart, kidneys, eyes, and nerves

How Often Should You Get Tested?

The frequency of testing depends on your initial results and risk factors:

New USPSTF and ADA guidelines recommend some adults be screened starting at age 35, and every 3 years after. However, if you have additional risk factors or your initial results show prediabetes, your doctor may recommend more frequent testing.

For those with PCOS, patients should have repeat diabetes screening every three to five years, or more often if other indications for screening are present.

Special Populations: Different Rules Apply

Asian Americans
A difference in body fat composition in Asian persons results in underestimation of risk based on BMI thresholds used to define overweight in the US. This means Asian Americans may need screening at lower BMI levels than other groups.

Children and Adolescents
After the onset of puberty or after 10 years of age, whichever occurs earlier. If tests are normal, repeat testing at a minimum of 3-year intervals (or more frequently if BMI is increasing or risk factor profile is deteriorating) is recommended.

Older Adults
The AAFP feels that there is currently insufficient evidence to recommend screening adults aged 35 to 39. Almost all of the evidence that was presented looked at adults over the age of 40 and there were no subgroup analyses that specifically examined screening at younger ages.

What Happens After Testing?

Getting tested is just the first step. Getting tested is simple and quick. Your blood will be drawn at your doctor's office or at a clinic so your blood sugar can be tested. Results are usually available quickly.

If your results show:

• Normal levels: Continue healthy habits and retest in 3 years (or sooner if risk factors change)
• Prediabetes: Work with your healthcare provider on lifestyle changes. Studies show you can reduce your risk of progressing to diabetes by up to 58% with diet and exercise
• Diabetes: Your doctor will likely repeat the test to confirm and then create a management plan

Taking Control of Your Health

Deciding to get tested for diabetes is an important step in taking control of your health. Remember, just over half (52%) of all US adults reported having a glucose test in the past 3 years, which means many people who should be tested aren't getting screened.

The good news is that testing is easier than ever. You can order tests directly without a doctor's visit, and results are private, not shared with insurance companies or added to your permanent medical record. This can be especially important if you're concerned about privacy or don't have easy access to healthcare.

Whether you have obvious risk factors or just want peace of mind, getting tested gives you valuable information about your health. Early detection means early action, and that can make all the difference in preventing or managing diabetes.

Ready to take the next step? Consider ordering a diabetes screening test today. It's a simple action that could have a profound impact on your future health.