Adults - Screening and Diagnosis

Question 1

Risk factors for DM type 2

Answer 1

• age 40+
• first degree relative
• high risk ethnicity
• hx of pre-DM or GDM
• hx of macrosomic infant
• end organ damage (retinopathy, neuropathy, nephropathy, CV)
• vascular risk factors
• associated diseases (separate card)
• meds (separate card)

Question 2

Risk factors for DM type 2

What associated diseases are risk factors for DM?

Answer 2

• pancreatitis
• PCOS
• acanthosis nigrans
• gout
• NASH
• MH: bipolar, depression, schizophrenia
• HIV
• OSA
• CF

Question 3

Risk factors for DM type 2

What medications are risk factors for DM?

Answer 3

• glucocorticoids
• atypical antipsychotics
• statins
• ARV
• anti-rejection drugs

Question 4

Risk factors for DM type 2

What are some vascular risk factors?

Answer 4

HDL <1 in males, <1.3 in females
TG >1.7
HTN
Obesity (esp abdo)
Smoking

Question 5

What are early signs of DM?

Answer 5

• recurrent infections (yeast, UTI)
• fatigue
• blurred vision

4 P’s:

• paresthesia
• polyuria
• polydipsia
• polyphagia

Question 6

How often should screening occur for:
-risk factors?

How often should DM screening occur

• if no risk factors?
• if presence of risk factors?

Answer 6

Screen risk factors ANNUALLY

If no risk factors:
age 40+: q3 years

If risk factors: q6-12 months

Question 7

What is the cut-off threshold for diagnosis of diabetes:

FPG:
A1C:
75 g OTT:
Random PG:

Answer 7

FPG: 7.0 and above
A1C: 6.5 and above

2 hr PG 75 OGTT: 11.1 and above
Random PG: 11.1

Question 8

DM screening using FPG and A1C:

• if one test is in diabetic range, what is the next step?
• if both tests are in diabetic range, what is the next step?

Answer 8

If no hyperglycemia symptoms:
• if ONE test is in diabetes range, repeat same test on a different day for confirmatory testing

• If BOTH in diabetes range, diagnosis confirmed

*if symptomatic then do not need to confirm before initiating treatment

Question 9

What is the range of FPG for impaired fasting glucose?

Answer 9

6.1-6.9

Question 10

What is the range of A1C for prediabetes?

Answer 10

6.0-6.4

Question 11

what tests to use for screening in elderly?

when to stop screening?

Answer 11

both A1C and fasting glucose

A1C progressively elevated in elderly

unlikely beneficial after age 80

Question 12

symptoms of diabetes in older adults?

Answer 12

Dehydration (altered thirst perception, delayed fluid intake)

Incontinence

Older adults tend to have vague symptoms (of course)

Dry eyes, dry mouth, confusion, diabetic complications

Weight loss / HONK

Geriatric syndromes: pain, incontinence, cognitive impairment, depression, falls, polypharmacy