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What Are The Criteria For Diagnosis Of Diabetes?

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  2. What Are The Criteria For Diagnosis Of Diabetes?
New Thresholds For Diagnosis Of Diabetes In Pregnancy

New Thresholds For Diagnosis Of Diabetes In Pregnancy

Share Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Updated guidelines on diabetes in pregnancy lower the fasting plasma glucose thresholds for diagnosis, and include new recommendations on self-management for women with type 1 diabetes. Around 35,000 women have either pre-existing or gestational diabetes each year in England and Wales. Nearly 90 per cent of the women who have diabetes during pregnancy, have gestational diabetes, which may or may not resolve after pregnancy. Rates have increased in recent years to due rising obesity rates among the general population, and increasing number of pregnancies among older women. Of the women with diabetes in pregnancy who do not have gestational diabetes, 7.5 per cent of women have type 1 diabetes, and the remainder have type 2 diabetes, both of which have also increased recently. Following a number of developments, such as new technologies and research on diagnosis and treatment of gestational diabetes, NICE has updated its guidelines on diabetes in pregnancy. Diagnosis Among the new recommendations are that a woman should be diagnosed with gestational diabetes if she has either a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above. NICE says this could help tackle current variation in the number in the glucose levels used for diagnosing gestational diabetes, and may lead to an incr Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Discussion Diagnostic Criteria In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus published a new classification scheme and revised diagnostic criteria for diabetes mellitus (the following criteria are from the 2013 revision). Classification of Diabetes Mellitus Diagnostic elements: genetic markers; autoantibodies, clinical characteristics (ketosis, pattern of progression, obesity, age and treatment response) Type 1: β-cell destruction usually leading to absolute insulin deficiency Type 2: Insulin resistance with insulin secretion deficiency. 90 - 95% of people who have diabetes have Type 2. Other specific types: Genetic defects in β-cell function Genetic defects in insulin action Exocrine pancreas diseases Endocrinopathies Drug- or chemical-induced Infections Other rare forms Gestational Diagnosis of Diabetes Mellitus (Any finding falling within a positive criteria should be repeated on a subsequent day with another test in any criteria set: e.g., a random plasma glucose with symptoms, might be followed-up with a fasting plasma glucose.) Fasting plasma glucose (FPG) ≥ 126 mg/dl (7.0 mmol/l) OR Symptoms (such as polyuria, polydipsia, unexplained weight loss) AND a random plasma glucose ≥ 200 mg/dl (11.1 mmol/l) OR Plasma glucose ≥ 200 mg/dl ( 11.1 mmol/l) 2 hours after a 75g glucose load OR A1C ≥ 6.5%. Categories of increased risk for diabetes (prediabetes): Fasting plasma glucose (FPG) levels: 100 to 125mg/dl (5.6 - 6.9mmol/l) [IFG]; OR 2-h PG values in the 75-g oral glucose tolerance test (OGIT)): 140 mg/dl to 199 mg/dl (7.8 - 11.0 mmol/l) [IGT]; OR A1C: 5.7 - 6.4%. Gestational Diabetes Mellitus (GDM) Screen at 24-28 weeks 75g OGTT: fasting: ≥ 92mg/dl (5.1 mmol/l) ; OR 1 hr: ≥ 180mg/dl (10.0 mmol/l); OR 2 hr: ≥ 153mg Continue reading >>

Diagnosis Of Diabetes Mellitus

Diagnosis Of Diabetes Mellitus

Diabetes is diagnosed on the basis of history (ie polyuria, polydipsia and unexplained weight loss) PLUS a random venous plasma glucose concentration >= 11.1 mmol/l OR a fasting plasma glucose concentration >= 7.0 mmol/l (whole blood >= 6.1 mmol/l) OR 2 hour plasma glucose concentration >= 11.1 mmol/l 2 hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT) With no symptoms diagnosis should not be based on a single glucose determination but requires confirmatory plasma venous determination. At least one additional glucose test result on another day with a value in the diabetic range is essential, either fasting, from a random sample or from the two hour post glucose load (1,2). If the fasting or random values are not diagnostic the 2-hour value should be used. These diagnostic criteria for diagnosing and classifying diabetes were applied to the management of diabetes in the UK from June 1st 2000 (1). The new criteria included lowering the threshold for diagnosing diabetes from a fasting glucose level of 7.8 mmol/l to 7.0 mmol/l. It should be noted that children usually present with severe symptoms and diagnosis should then be based on a single raised blood glucose result, as above. Immediate referral to a Paediatric Diabetes Team should not be delayed. A diagnosis should never be made on the basis of glycosuria or a stick reading of a finger prick blood glucose alone, although such tests may be useful for screening purposes. HbA1c in the diagnosis of diabetes mellitus (3) HbA1c can be used as a diagnostic test for diabetes providing that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement an HbA Continue reading >>

Diabetes Mellitus: Diagnosis And Screening

Diabetes Mellitus: Diagnosis And Screening

Based on etiology, diabetes is classified as type 1 diabetes mellitus, type 2 diabetes mellitus, latent autoimmune diabetes, maturity-onset diabetes of youth, and miscellaneous causes. The diagnosis is based on measurement of A1C level, fasting or random blood glucose level, or oral glucose tolerance testing. Although there are conflicting guidelines, most agree that patients with hypertension or hyperlipidemia should be screened for diabetes. Diabetes risk calculators have a high negative predictive value and help define patients who are unlikely to have diabetes. Tests that may help establish the type of diabetes or the continued need for insulin include those reflective of beta cell function, such as C peptide levels, and markers of immune-mediated beta cell destruction (e.g., autoantibodies to islet cells, insulin, glutamic acid decarboxylase, tyrosine phosphatase [IA-2α and IA-2β]). Antibody testing is limited by availability, cost, and predictive value. Prevention, timely diagnosis, and treatment are important in patients with diabetes mellitus. Many of the complications associated with diabetes, such as nephropathy, retinopathy, neuropathy, cardiovascular disease, stroke, and death, can be delayed or prevented with appropriate treatment of elevated blood pressure, lipids, and blood glucose.1–4 In 1997, the American Diabetes Association (ADA) introduced an etiologically based classification system and diagnostic criteria for diabetes,5 which were updated in 2010.1 Type 2 diabetes accounts for approximately 90 to 95 percent of all persons with diabetes in the United States, and its prevalence is increasing in adults worldwide.6 With the rise in childhood obesity, type 2 diabetes is increasingly being diagnosed in children and adolescents.6 Clinical recommendati Continue reading >>

Report Of The Committee

Report Of The Committee

Report of the Committee on the classification and diagnostic criteria of diabetes mellitus The Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus Yutaka Seino • Kishio Nanjo • Naoko Tajima • Takashi Kadowaki • Atsunori Kashiwagi • Eiichi Araki • Chikako Ito • Nobuya Inagaki • Yasuhiko Iwamoto • Masato Kasuga • Toshiaki Hanafusa • Masakazu Haneda • Kohjiro Ueki � The Japan Diabetes Society 2010 Keywords Diabetes mellitus � Clinical diagnosis � HbA1c Summary Concept of diabetes mellitus Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long-term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder. Classification (Tables 1, 2; Fig. 1) The classification of glucose metabolism disorders is principally derived from etiology, and includes staging of pathophysiology based on the degree of deficiency of insulin action. These disorders are classified into four groups: (i) type 1 diabetes mellitus; (ii) type 2 diabetes mellitus; (iii) diabetes mellitus those due to other specific mechanisms or diseases; and (iv) gestational diabetes mellitus. Type 1 diabetes is characterized by destruction of pancreatic b-cells. Type 2 diabetes is characterized by combinations of decreased insulin secretion and decreased insulin sensitivity (insulin Continue reading >>

Misdiagnosis By Design - The Story Behind The Ada Diagnostic Criteria

Misdiagnosis By Design - The Story Behind The Ada Diagnostic Criteria

This is the little known story of how--and why--the American Diabetes Association keeps doctors from diagnosing Type 2 diabetes early. If you wait for your doctor to give you a diabetes diagnosis, the chances are good that by the time you are diagnosed you'll already have one or more serious diabetic complications. These include retinal damage, nerve damage, and early kidney damage. It is now known that these diabetic complications only develop after years of chronic exposure to high blood sugars. But, tragically, the way that today's doctors are forced to diagnose diabetes ensures that you will get no warning that you are experiencing those chronically high blood sugars until they have reached a level so high they have already done irreversible damage. This is not an accident. Years ago a committee of medical experts whose task was to decide how diabetes should be diagnosed decided it was better to avoid diagnosing patients with diabetes than to give them early warning that they were suffering from elevated blood sugars. As a result, these medical experts intentionally set the standards for diagnosing diabetes artificially high, so that most patients do not get diagnosed until their blood sugar has reached a level where they may soon develop the diabetic eye disease that leads to blindness. Their reasons for doing this this made sense in the late 1970s when these diagnostic criteria were originally crafted. At that time there was no treatment that could help people with early diabetes, while delivering a diabetes diagnosis could make it impossible for their patients to get health or life insurance. These circumstances led the experts to conclude that an early diagnosis of diabetes was more likely to harm than help their patients. So they defined diagnostic criteria tha Continue reading >>

Criteria For Diagnosis Of Diabetes

Criteria For Diagnosis Of Diabetes

Glucose Tolerance Test To remain consistent with the American Diabetes Association’s (ADA) recommended criteria for diagnosing diabetes, Regional Medical Laboratory has made changes to our orderable tests, reference ranges and interpretive data. Screening and Diagnosis of Gestational Diabetes The screening test for gestational diabetes is a serum or plasma glucose level one hour after a 50 gram glucose challenge. The patient is not required to be fasting prior to the 1-hour screening test. The orderable test is GLUC 1 HR. Glucose levels greater than 135 mg/dL should be followed by a 3-hour glucose tolerance test. Gestational diabetes is diagnosed if two or more values of a 3-hour glucose tolerance test are above the reference range. The orderable test is GTT PREG Fasting: 70-95 mg/dL Post 1-hour: 70-180 mg/dL Post 2-hour: 70-155 mg/dL Post 3-hour: 70-140 mg/dL Diagnosis of Diabetes in non-Pregnant Individuals The American Diabetes Association states to diagnose diabetes in a non-pregnant individual, one of the following criteria must be met: Random plasma glucose greater than 200 mg/dL with symptoms (polyuria, polydypsia, and unexplained weight loss) repeated to confirm on a subsequent day. Fasting plasma glucose greater than 126 mg/dL repeated to confirm on a subsequent day. 2-hour plasma glucose greater than 200 mg/dL post 75-gram glucose challenge repeated to confirm on a subsequent day. The patient must be fasting. The orderable test is GLUC 2 HR. A result of 135 to 200 mg/dl post 75 gram glucose challenge is diagnostic of impaired glucose tolerance (pre-diabetes). If you have any questions, you may contact Dr. Caitlin Schein M.D. at (918) 744-2553 or 1-800-722-8077, or by email at [email protected]. Continue reading >>

Criteria For Diagnosing Diabetes - Topic Overview

Criteria For Diagnosing Diabetes - Topic Overview

To be diagnosed with diabetes, you must meet one of the following criteria:1 Have symptoms of diabetes (increased thirst, increased urination, and unexplained weight loss) and a blood sugar level equal to or greater than 200 milligrams per deciliter (mg/dL). The blood sugar test is done at any time, without regard for when you last ate (random plasma glucose test or random blood sugar test). Have a fasting blood sugar level that is equal to or greater than 126 mg/dL. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for 8 hours. Have a 2-hour oral glucose tolerance test (OGTT) result that is equal to or greater than 200 mg/dL. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes). Have a hemoglobin A1c that is 6.5% or higher. Your doctor may repeat the test to confirm the diagnosis of diabetes. If the results of your fasting blood sugar test are between 100 mg/dL and 125 mg/dL, your OGTT result is between 140 to 199 mg/dL (2 hours after the beginning of the test), or your hemoglobin A1c is 5.7% to 6.4%, you have prediabetes. This means that your blood sugar is above normal but not high enough to be diabetes. Discuss with your doctor how often you need to be tested.1 Continue reading >>

Who Diagnostic Criteria As A Validation Tool For The Diagnosis Of Diabetes Mellitus: A Study In Five European Countries

Who Diagnostic Criteria As A Validation Tool For The Diagnosis Of Diabetes Mellitus: A Study In Five European Countries

Objective: In 1999, the World Health Organization (WHO) published new diagnostic criteria for diabetes mellitus (DM). The cut-off value of the fasting plasma glucose concentration was lowered from 7.8 to 7.0 mmol/l. The WHO criteria were used to validate the diagnosis made by the general practitioner, and to compare the diagnostic validity of diabetes mellitus in different countries. Methods: We retrospectively analysed 2556 newly diagnosed diabetics. Incidence was calculated according to the 1999 WHO criteria. Data were collected in general practice networks in five European countries or regions (Belgium, England, the Netherlands, Portugal, Spain). Results: According to the WHO criteria, 82% of the cases were valid diagnoses. Compared to the total group, in Spain, significantly more diagnoses were in agreement with the WHO criteria, whereas this number was significantly lower in England and Portugal. From the patients whose diagnosis was not in agreement with the WHO criteria, significantly more were women than men. Conclusion: By using the WHO diagnostic criteria, the international standard, as a validation tool, we show that the diagnoses of diabetes mellitus made in primary care are valid. Furthermore, we show that these diagnoses are comparable between countries. Therefore, information from general practice registration networks is a valuable and valid source for international comparisons. Continue reading >>

Criteria For Diagnosing Diabetes

Criteria For Diagnosing Diabetes

Topic Overview Have symptoms of diabetes (increased thirst, increased urination, and unexplained weight loss) and a blood sugar level equal to or greater than 11.1 millimoles per litre (mmol/L). The blood sugar test is done at any time, without regard for when you last ate (random plasma glucose test or random blood sugar test). Have a fasting blood sugar level that is equal to or greater than 7.0 mmol/L. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for 8 hours. Have a 2-hour oral glucose tolerance test (OGTT) result that is equal to or greater than 11.1 mmol/L. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes). Have a hemoglobin A1c that is 6.5% or higher. (This test is most reliable for adults. Some experts recommend using one of the other tests to diagnose diabetes in children.)1 Your doctor may repeat the test to confirm the diagnosis of diabetes. If the results of your fasting blood sugar test are between 6.1 to 6.9 mmol/L, your OGTT result is between 7.8 to 11.0 mmol/L (2 hours after the beginning of the test), or your hemoglobin A1c is 6.0% to 6.4%, you have prediabetes. This means that your blood sugar is above normal but not high enough to be diabetes. Discuss with your doctor how often you need to be tested.2 Continue reading >>

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

INTRODUCTION The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice. The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003 and 2010 [1-3]. The diagnosis is based on one of four abnormalities: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT) (table 1). Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as having increased risk for diabetes or prediabetes. (See 'Diagnostic criteria' below.) Screening for and prevention of diabetes is reviewed elsewhere. The etiologic classification of diabetes mellitus is also discussed separately. (See "Screening for type 2 diabetes mellitus" and "Prevention of type 2 diabetes mellitus" and "Prevention of type 1 diabetes mellitus" and "Classification of diabetes mellitus and genetic diabetic syndromes".) CLINICAL PRESENTATION Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. The majority of patients are asymptomatic, and hyperglycemia is noted on routine laboratory evaluation, prompting further testing. The frequency of symptomatic diabetes has been decreasing in parallel wi Continue reading >>

New Classification And Diagnostic Criteria For Diabetes Mellitus

New Classification And Diagnostic Criteria For Diabetes Mellitus

Abstract There has been an explosive growth in knowledge about diabetes mellitus since the National Diabetes Data Group promulgated diagnostic criteria and a classification system in 1979 that was largely adopted by the World Health Organization. However, recent findings regarding the levels of glucose associated with development of retinopathy, and growing confusion caused by a system of classification of diabetes based largely on the treatment used have led to a new assessment of the diagnosis and classification of diabetes mellitus. Using new data from population-based studies, and placing emphasis on a pathophysiology-based system of classification, in 1997, the Expert Committee of the American Diabetes Association released its recommendations for the classification and diagnosis of diabetes. The major changes from the 1979 report include: (a) the preferred use of the terms “type 1” and “type 2” instead of “insulin-dependent” and “non-insulin-dependent” to designate the two major types of diabetes mellitus; (b) a simplification of the diagnostic test to two fasting plasma glucose (FPG) determinations; and (c) a lower cutoff for FPG (126 mg/dL) to diagnose diabetes (this level of FPG having been found equivalent to the 200-mg/dL value in the oral glucose tolerance test for diagnosis). These changes provide an easier and more reliable means of diagnosing persons at risk of complications of hyperglycemia. Even though the fasting criterion was lowered, the total number of persons who will be diagnosed with diabetes by exclusive reliance on FPG will actually be somewhat less than with the old criteria. Moreover, epidemiologic data support the recommendation that screening for diabetes should start at age 45 and be repeated every 3 years in persons without Continue reading >>

New Ada Guidelines For Diagnosis, Screening Of Diabetes

New Ada Guidelines For Diagnosis, Screening Of Diabetes

The American Diabetes Association now includes hemoglobin A1c in its diagnosis guidelines. In 2010, it got a little easier to diagnose diabetes. Diabetes mellitus is a chronic disorder of glucose metabolism that affects 23.6 million people in the U.S.1 The four major types of diabetes differ in their causes, but all types have hyperglycemia in common. These are type 1 (formerly called insulin dependent or juvenile diabetes), type 2, gestational diabetes mellitus (GDM) and diabetes due to other causes. Chronic complications common to all forms include retinopathy, nephropathy, neuropathy and cardiovascular disease. Individuals who are able to keep their blood glucose close to the normal range have the lowest risk of microvascular complications;2,3 managing lipidemia and hypertension improves macrovascular outcomes as well.4 Early diagnosis affords early intervention. Diagnosis of diabetes has historically been by measuring fasting plasma glucose (FPG) or performing an oral glucose tolerance test (OGTT); specific threshold values are required to categorize an individual as pre-diabetic (increased risk for diabetes) and diabetic (Table 1). For individuals without unequivocal hyperglycemia, positive results must be repeated on a separate day.5 Type 2 Diabetes Type 2 diabetes accounts for 90-95% of the cases in the U.S. Risk factors are obesity and being overweight, race, age, family history, hypertension, gestational diabetes and physical inactivity.6 Individuals with symptoms such as blurred vision, polydipsia and polyuria should be tested when they present with these symptoms.7 Asymptomatic individuals with risk factors should be screened for diabetes if they are overweight (BMI > 25 kg/m2) and have additional risk factors,5 or beginning at age 45 for those without other Continue reading >>

Diabetes Mellitus: Screening And Diagnosis

Diabetes Mellitus: Screening And Diagnosis

Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>

Diabetes Tests & Diagnosis

Diabetes Tests & Diagnosis

Your health care professional can diagnose diabetes, prediabetes, and gestational diabetes through blood tests. The blood tests show if your blood glucose, also called blood sugar, is too high. Do not try to diagnose yourself if you think you might have diabetes. Testing equipment that you can buy over the counter, such as a blood glucose meter, cannot diagnose diabetes. Who should be tested for diabetes? Anyone who has symptoms of diabetes should be tested for the disease. Some people will not have any symptoms but may have risk factors for diabetes and need to be tested. Testing allows health care professionals to find diabetes sooner and work with their patients to manage diabetes and prevent complications. Testing also allows health care professionals to find prediabetes. Making lifestyle changes to lose a modest amount of weight if you are overweight may help you delay or prevent type 2 diabetes. Type 1 diabetes Most often, testing for occurs in people with diabetes symptoms. Doctors usually diagnose type 1 diabetes in children and young adults. Because type 1 diabetes can run in families, a study called TrialNet offers free testing to family members of people with the disease, even if they don’t have symptoms. Type 2 diabetes Experts recommend routine testing for type 2 diabetes if you are age 45 or older are between the ages of 19 and 44, are overweight or obese, and have one or more other diabetes risk factors are a woman who had gestational diabetes1 Medicare covers the cost of diabetes tests for people with certain risk factors for diabetes. If you have Medicare, find out if you qualify for coverage . If you have different insurance, ask your insurance company if it covers diabetes tests. Though type 2 diabetes most often develops in adults, children also ca Continue reading >>

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