Diabetes mellitus screening

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Diabetes mellitus

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ADA Standards of Medical Care in Diabetes—2014

Patient information

Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Gestational Diabetes

Overview

Historical Perspective

Classification

Pre-Diabetics

Impaired Fasting Glycaemia
Impaired Glucose Tolerance

Diabetics

Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes Mellitus
Other Causes

Pathophysiology

Causes

Epidemiology and Demographics

Differentiating Diabetes Mellitus from other Diseases

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

General Management

Dietary Management

Medical Therapy

Diabetes with Hypertension Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Social Issues

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]

Overview

The 2013 ADA guidelines for screening population for DM type 2 recommend screening all individuals without risk factors, every 3 years beginning at 45 years of age. It can be pursued in a younger age group with a BMI ≥ 25 and other risk factors. The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test.

Screening

Diabetes Mellitus Type 1

  • Generally, patients with Type 1 DM initially present with life-threatening complications such as diabetic ketoacidosis and markedly elevated blood glucose levels.
  • Screening for Type 1 DM includes a battery of metabolic, genetic and immunologic tests.
  • However, wide-spread screening of children with Type 1 DM is not currently recommended as this would diagnose a very small subset of general population who are at risk of having this condition.
  • 2013 ADA guidelines suggest screening for DM type 1 with an anti-islet cell antibody screen in patients having relatives diagnosed with Type 1 DM for the purpose of a clinical research study (Level of Evidence E).
  • However, a positive test result should be followed by counselling about symptoms, close monitoring to detect onset of diabetes mellitus type 1, and measures to prevent ketoacidosis.

American Diabetes Association Recommendations for Diabetes Screening (DO NOT EDIT)[1][2][3]

The ADA's expert opinion suggests screening for diabetes as follows:

  • The general population should be screened every 3 years, beginning at age 45 (especially if their BMI>25kg/m2).
  • Younger individuals should be screened if they have BMI>25kg/m2 and at least one other risk factor-
    • sedentary life style
    • 1st degree relative with DM
    • African American, Native American, Latino, Asian American, Pacific Islander
    • Low HDL-C
    • gestational DM
    • polycystic ovary syndrome
    • vascular disease
    • insulin resistance
    • prior test showing increased risk of DM.

The US Preventive Services Task Force Recommendations for Diabetes Screening (DO NOT EDIT)[1]

  • The US Preventive Services Task Force recommends screening all adults with blood pressure >135/80 for diabetes.
  • The fasting plasma glucose, 2H oral glucose tolerance test, or the A1C may be used for screening.

Medical Conditions Associated with Increased Diabetes Risks

Many medical conditions are associated with diabetes and warrant screening. A partial list includes:

2013 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)[4]

Testing For Diabetes in Asymptomatic Patients

"1. Testing to detect type 2 diabetes and prediabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI≥25 kg/m2) and who have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. (Level of Evidence: B)"
"2. If tests are normal, repeat testing at least at 3-year intervals is reasonable. (Level of Evidence: E)"
"3. To test for diabetes or prediabetes, the A1C, FPG, or 75-g 2-h OGTT are appropriate. (Level of Evidence: B)"
"4. In those identified with prediabetes, identify and, if appropriate, treat other CVD risk factors. (Level of Evidence: B)"

Screening for Type 2 Diabetes in Children

"1. Testing to detect type 2 diabetes and prediabetes should be considered in children and adolescents who are overweight and who have two or more additional risk factors for diabetes. (Level of Evidence: E)"

Screening for Type 1 Diabetes

"1. Consider referring relatives of those with type 1 diabetes for antibody testing for risk assessment in the setting of a clinical research study. (Level of Evidence: E)"

Screening for Gestational Diabetes (GDM)

"1. Screen for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. (Level of Evidence: B)"
"2. In pregnant women not previously known to have diabetes, screen for GDM at 24–28 weeks of gestation, using a 75-g 2-h OGTT. (Level of Evidence: B)"
"3. Screen womenwithGDMfor persistent diabetes at 6–12 weeks postpartum, using the OGTT and nonpregnancy diagnostic criteria. (Level of Evidence: E)"
"4. Women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. (Level of Evidence: B)"
"4. Women with a history of GDM found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes. (Level of Evidence: A)"

Coronary Heart Disease (CHD) Screening

"1. In asymptomatic patients, routine screening for CAD is not recommended, as it does not improve outcomes as long as CVD risk factors are treated.(Level of Evidence: A)"

References

  1. 1.0 1.1 Resnick HE, Harris MI, Brock DB, Harris TB (2000). "American Diabetes Association diabetes diagnostic criteria, advancing age, and cardiovascular disease risk profiles: results from the Third National Health and Nutrition Examination Survey.". Diabetes Care 23 (2): 176-80. PMID 10868827.
  2. Lee CM, Huxley RR, Lam TH, et al (2007). "Prevalence of diabetes mellitus and population attributable fractions for coronary heart disease and stroke mortality in the WHO South-East Asia and Western Pacific regions". Asia Pacific journal of clinical nutrition 16 (1): 187–92. PMID 17215197.
  3. Seidell JC (2000). "Obesity, insulin resistance and diabetes--a worldwide epidemic". Br. J. Nutr. 83 Suppl 1: S5–8. PMID 10889785.
  4. American Diabetes Association (2013). "Standards of medical care in diabetes--2013.". Diabetes Care 36 Suppl 1: S11-66. doi:10.2337/dc13-S011. PMID 23264422.

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