Screening and Diagnosis of Type 2 Diabetes in Sickle Cell Disease.

Background: Diagnosing type 2 diabetes mellitus (T2DM) in people with sickle cell disease (SCD) is complicated due to hemoglobin A variance in affected individuals. Accurate screening assessments are needed to prevent excessive morbidity and mortality. Primary care physicians need recommendations for screening and diagnosis in this unique population.

Purpose: To synthesize recommendations regarding medical diagnosis criteria for T2DM in SCD.

Data sources: PubMed, Standards of Medical Care in Diabetes, US Preventative Services Task Force, National Institute of Diabetes and Digestive and Kidney Diseases, searched on December 28, 2022.

Study selection: One reviewer searched each database to select applicable studies pertaining to "sickle cell disease," "type 2 diabetes," "HbA1c," and "fructosamine" from December 28, 2022, to March 15, 2023.

Data extraction and quality assessment: A comprehensive literature review was done to extract current data/facts and assess certainty of evidence.

Data synthesis: This review reviews 5 articles that met inclusion criteria to outline outpatient screening and diagnosis of T2DM in SCD. Based on these findings, we recommend fasting plasma glucose as the standard screening starting at age 35 based on USPSTF guidelines. We do not recommend using HbA1c, fructosamine, or glycated albumin for screening or diagnosis of T2DM in individuals with SCD; the latter entities have limited implications in their use.

Limitations: There are limited studies available for diagnosis of T2DM in SCD.

Conclusions: Fasting plasma glucose is the standard screening for T2DM for SCD to ensure early diagnosis and prevent worsening macro and microvascular complications from both comorbid conditions.