Diabetes mellitus screening
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.
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.
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)
- 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:
- Elevated cholesterol levels,
- Coronary artery disease
- History of gestational diabetes
- Polycystic ovary syndrome
- Chronic pancreatitis
- Fatty liver
- Cystic fibrosis
- Mitochondrial neuropathies and myopathies
- Myotonic dystrophy
- Friedreich's ataxia
- Some of the inherited forms of neonatal hyperinsulinism.
- The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics).
2013 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)
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)"|
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- 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.