Classification and Diagnosis Flashcards
Describe the 4 criteria for the diagnosis of diabetes
- HbA1c >= 6.5% (conducted in NGSP certified lab)
- FPG >= 126 mg/dL (8 hr fasting)
- 2 hr PG >= 200 mg/dL during 75 gm OGTT
- Patient with classic symptoms of hyperglycemia + random CBG >= 200 mg/dL
(ADA) Who should be screened for diabetes?
Patients with BMI >= 25 or BMI >= 23 in Asians plus an additional risk factor:
- physical inactivity
- first-degree relative with DM
- high-risk race/ethnicity (African American, Latino, Native American, Pacific Islander)
- Women w/ baby > 9 lbs at birth or GDM
- HTN (>=140/90 or on HTN meds)
- HDL 250 mg/dL
- Women with PCOS
- A1c >= 5.7%, IGT, or IFG on previous testing
- Conditions associated with insulin resistance (severe obesity, acanthosis nigricans)
- Hx CVD
All patients, particularly those who are overweight or obese, should be screened for diabetes starting at what age?
45 years old
Even if without risk factors
How often should patients with pre diabetes be tested for progression?
Yearly
Patients with normal DM screening should have tests repeated at a minimum of every ______
Minimum of every 3 years or more frequently if risk factors change
What are the criteria/lab values for pre-diabetes?
Any of the following:
- HbA1c 5.7 - 6.4%
- FPG 100 - 125 mg/dL
- 2-hr PG of 140 - 199 mgdL after 75 gm OGTT
When should asymptomatic children be tested for T2DM?
When overweight (BMI > 85th percentile, Wt > 85th percentile, or Wt > 120% IBW) plus 2 risk factors:
- Family hx T2DM in 1st or 2nd degree relative
- High risk race/ethnicity
- Signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, small-for-gestational-age birth wt)
- Maternal hx of DM or GDM during child’s gestation
At what age should DM screening begin for high-risk children?
Age 10 or at onset of puberty, if puberty occurs at a younger age
How often should high-risk children be screened for DM?
Every 3 years
When should pregnant women be screened for GDM?
- Patients with DM risk factors should be screened at first prenatal visit for undiagnosed T2DM
- All women should be screened at 24 - 28 weeks
When and how should postpartum GDM patients be screened for persistent DM?
Screen at 6 - 12 weeks postpartum and use the OGTT
If a women with a hx of GDM is found to have pre-diabetes, what are the recommended treatments?
Lifestyle interventions or metformin to prevent progression to DM
What is the one-step strategy for screening patients for GDM?
75 gm OGTT after 8 hours of fasting. Diagnosis is made if any glucose value is:
- Fasting >= 92 mg/dL
- 1 hr >= 180 mg/dL
- 2 hr >= 153 mg/dL
What is the two-step strategy for screening patients for GDM?
Step 1: 50 gm OGTT (non-fasting) and if 1 hr post glucose >= 140 mg/dL move to step 2 (Note: ACOG recommends >=135 in high risk ethnic groups)
Step 2: 100 gm OGTT (fasting). There are two different cutoffs depending on which guidelines are used. Diagnosis is made if any glucose value is:
- Fasting >= 95 ( or 105 mg/dL)
- 1 hr >= 180 ( or 190 mg/dL)
- 2 hr >= 155 ( or 165 mg/dL)
- 3 hr >= 140 ( or 145 mg/dL)
What is MODY?
Maturity-Onset Diabetes of the Young. Rare form of DM that differs from T1DM and T2DM. Caused by gene mutations that are strongly inherited. (High probability if DM present in 3 generations)
Also called monogenic DM
