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Who Criteria For Diagnosing Diabetes Mellitus?

Criteria For Diagnosing Diabetes

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. The diagnosis of diabetes needs to be confirmed by repeating the same blood sugar test or doing a different test on another day. 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 >>

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 >>

Diagnostic Criteria For Diabetes Mellitus

Diagnostic Criteria For Diabetes Mellitus

To the Editor: In his editorial article (1), Dr. Sacks welcomes the new guidelines for diagnosis of diabetes published recently by the American Diabetes Association (ADA) (2). Replacement of the oral glucose tolerance test (OGTT) by measurement of fasting plasma glucose (FPG) on more than one occasion certainly simplifies the diagnostic procedure, and the chosen FPG cutoff of ≥7.0 mmol/L (≥126 mg/dL) appears to be almost as sensitive for diabetes detection as the OGTT 2-h plasma glucose (2hPG). Unfortunately, the situation is not quite as simple as that. We recently conducted a survey of 401 nonpregnant subjects having OGTT because of suspected diabetes mellitus (3). The OGTT was performed according to WHO protocol and interpreted on the basis of the 2hPG value. The prevalence of diabetes in this population according to the results of the OGTT was 44.4%, compared with 41.4% by the ADA FPG criterion. This is in line with the ADA’s data on the different sensitivities of the two tests and suggests that they are giving approximately the same answers. However, when we compared results by the two methods for individual patients, the agreement was not always so good. Of 178 patients positive for diabetes by 2hPG, only 139 were positive by the ADA FPG criterion, which means the latter gave 39 (22%) false negatives if the OGTT 2hPG is regarded as the reference method. This discrepancy was not immediately apparent in the prevalence figures because 27 other subjects were falsely positive by the ADA criterion, and these partially balanced the false negatives. In its overall view of the situation, the ADA seems to have omitted considering in any detail the possibility of a substantial number of individual discrepancies within the population. Furthermore, subjects whose FPG is 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 >>

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 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. (This test is most reliable for adults. Some experts recommend using one of the other tests to diagnose diabetes in children.2) 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 Topic Overview 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 (fasti Continue reading >>

Diagnosis Of Type 2 Diabetes Mellitus

Diagnosis Of Type 2 Diabetes Mellitus

There is a continuum of risk for poor patient outcomes as glucose tolerance progresses from normal to overt type 2 diabetes. AACE-defined glucose tolerance categories are listed in Table 1.1 Table 1. Glucose Testing and Interpretation1 Normal High Risk for Diabetes Diabetes FPG < 100 mg/dL IFG FPG ≥100-125 mg/dL FPG ≥126 mg/dL 2-hour PG <140 mg/dL (measured with an OGTT performed 2 hours after 75 g oral glucose load taken after 8-hour fast) IGT 2-hour PG ≥140-199 mg/dL 2-hour PG ≥200 mg/dL Random PG ≥200 mg/dL plus symptoms of diabetes (polyurea, polydipsia, or polyphagia) A1C < 5.5% 5.5% to 6.4% For screening of prediabetesa ≥6.5% Secondaryb Abbreviations: A1C = hemoglobin A1C; FPG = fasting plasma glucose; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; PG = plasma glucose. a A1C should be used only for screening prediabetes. The diagnosis of prediabetes, which may manifest as either IFG or IGT, should be confirmed with glucose testing. b Glucose criteria are preferred for the diagnosis of DM. In all cases, the diagnosis should be confirmed on a separate day by repeating glucose or A1C testing. When A1C is used for diagnosis, follow-up glucose testing should be done when possible to help manage diabetes. The diagnostic cut points recommended by the American Diabetes Association (ADA) differ slightly from the AACE recommendations; please see the ADA Standards of Medical Care in Diabetes for details.2 In addition to glucose criteria, type 1 diabetes (T1D) is diagnosed according to the presence of autoantibodies to glutamic acid decarboxylase, pancreatic islet (beta) cells, or insulin.1,2 Type 2 diabetes (T2D) accounts for 90% of diabetes cases and is usually identified in individuals 30 years or older who are overweight or obese and/or have Continue reading >>

New Look At Screening And Diagnosing Diabetes Mellitus | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

New Look At Screening And Diagnosing Diabetes Mellitus | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

Objective: Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria to make case finding easier for clinicians and patients. Participants: R.M.B. invited experts in the area of diagnosis, monitoring, and management of diabetes to form a panel to review the literature and develop consensus regarding the screening and diagnosis of diabetes with particular reference to the use of hemoglobin A1c (HbA1c). Participants met in open session and by E-mail thereafter. Metrika, Inc. sponsored the meeting. Evidence: A literature search was performed using standard search engines. Consensus Process: The panel heard each members discussion of the issues, reviewing evidence prior to drafting conclusions. Principal conclusions were agreed on, and then specific cut points were discussed in an iterative consensus process. Conclusions: The main factors in support of using HbA1c as a screening and diagnostic test include: 1) HbA1c does not require patients to be fasting; 2) HbA1c reflects longer-term glycemia than does plasma glucose; 3) HbA1c laboratory methods are now well standardized and reliable; and 4) errors caused by nonglycemic factors affecting HbA1c such as hemoglobinopathies are infrequent and can be minimized by confirming the diagnosis of diabetes with a plasma glucose (PG)-specific test. Specific recommendations include: 1) screening standards should be established that prompt further testing and closer follow-up, including fasting PG of 100 mg/dl or greater, random PG of 130 mg/dl or greater, or HbA1c greater than 6.0%; 2) HbA1c of 6.56.9% or greater, confirmed by a PG-specific test (fas Continue reading >>

Type 2 Diabetes Worldwide According To The New Classification And Criteria

Type 2 Diabetes Worldwide According To The New Classification And Criteria

Paul Z. Zimmet, MD, PHD, FRACP Daniel McCarty, PHD Maximilian de Courten, MD Two major reports have recently revised the classification of and diagnostic criteria for diabetes. Classification was previously based on the need for insulin (insulin-dependent or non–insulin-dependent), but this has become increasingly confusing. Now, the type of diabetes is determined by the etiological process rather than the treatment modality. Type 1 diabetes is thus characterized by islet cell destruction and type 2 diabetes by a combination of defects in insulin secretion and action. An individual with either type of diabetes may be on any treatment modality. This classification should prove to be more logical and, for example, allow latent autoimmune diabetes in adults, which typically does not require insulin at presentation, to be classified as type 1 diabetes. The fasting plasma glucose diagnostic threshold for diabetes has been lowered to 7.0 mmol/l (126 mg/dl), and impaired fasting glucose (fasting plasma glucose 6.1–6.9 mmol/l [110–125 mg/dl]) has been introduced as a new category of intermediate glucose metabolism. These changes recognize that the old fasting threshold did not match the 2-h (postload) threshold well and that both micro- and macrovascular disease develop at lower fasting glucose levels than previously recognized. Although the prevalences of diabetes according to the new fasting and 2-h criteria are now similar in most populations, the actual individuals identified as having diabetes are often different. Over 30% of all those with diabetes have a nondiabetic fasting glucose but still have increased cardiovascular mortality. Thus, it is important to retain the oral glucose tolerance test for the diagnosis of diabetes. CHANGES IN CLASSIFICATION — In 1979 an Continue reading >>

Criteria For Diagnosing Diabetes

Criteria For Diagnosing Diabetes

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. The diagnosis of diabetes needs to be confirmed by repeating the same blood sugar test or doing a different test on another day. 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 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. (This test is most reliable for adults. Some experts recommend using one of the other tests to diagnose diabetes in children.2) 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 >>

Criteria For Diagnosing Diabetes

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. (This test is most reliable for adults. Some experts recommend using one of the other tests to diagnose diabetes in children.2) 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 >>

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 >>

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 >>

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

Classification, Pathophysiology, Diagnosis And Management Of Diabetes Mellitus

University of Gondar, Ethopia *Corresponding Author: Habtamu Wondifraw Baynes Lecturer Clinical Chemistry University of Gondar, Gondar Amhara 196, Ethiopia Tel: +251910818289 E-mail: [email protected] Citation: Baynes HW (2015) Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. J Diabetes Metab 6:541. doi:10.4172/2155-6156.1000541 Copyright: © 2015 Baynes HW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia either immune-mediated (Type 1 diabetes), insulin resistance (Type 2), gestational or others (environment, genetic defects, infections, and certain drugs). According to International Diabetes Federation Report of 2011 an estimated 366 million people had DM, by 2030 this number is estimated to almost around 552 million. There are different approaches to diagnose diabetes among individuals, The 1997 ADA recommendations for diagnosis of DM focus on fasting Plasma Glucose (FPG), while WHO focuses on Oral Glucose Tolerance Test (OGTT). This is importance for regular follow-up of diabetic patients with the health care provider is of great significance in averting any long term complications. Keywords Diabetes mellitus; Epidemiology; Diagnosis; Glycemic management Abbreviations DM: Diabetes Mellitus; FPG: Fasting Plasma Glucose; GAD: Glutamic Acid Decarboxylase; GDM: Gestational Diabetes Mellitus; HDL-cholesterol: High Density Lipoprotein cholesterol; HLA: Human Leucoid Antigen; IDD Continue reading >>

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