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
What is LADA?
Latent Autoimmune Diabetes of Adults. Sometimes called “Type 1.5 DM” or “double diabetes.” Characterized by latent progression to insulin dependence, presence of autoantibodies, and some insulin resistance.
Patients with cystic fibrosis should be screened for DM starting at what age? Via what screening method?
Starting at 10 years old using the OGTT (A1c not recommended).
What ethnicities are at higher risk of developing T2DM?
- Native Americans
- African Americans
- Latino
- Asian Americans
- Pacific Islanders
(AACE/ACE)
Clinicians may consider screening patients yearly for DM if they have 2 or more risk factors. What are the risk factors?
- CVD
- Family hx T2DM
- Overweight or obese
- At risk ethnic group
- HDL 250 mg/dL
- IGT, IFG, and/or metabolic syndrome
- PCOS, acanthosis nigricans, NAFLD
- HTN (140/90 or on tx for HTN)
- Hx GDM or delivering baby more than 9 lbs
- Antipsychotic therapy for schizophrenia and/or severe bipolar dz
- Chronic glucocorticoid exposure
- Sleep disorders in the presence of glucose intolerance (pre-DM + OSA, chronic sleep deprivation, night-shift occupation)
What tests require repeat testing for confirmation of DM diagnosis and which do not?
All tests should be confirmed a different day using the same test (HBA1c or plasma glucose) except when glucose >= 200 me/dL and having classic sx
What condition is considered a pre diabetes equivalent?
Metabolic Syndrome (as defined by NCEP ATP III criteria)
T1DM is characterized by absolute insulin deficiency. How should the dx be confirmed?
- Insulin levels
- C-peptide levels
- Check for autoantibodies to:
- glutamic acid decarboxylase
- pancreatic islet beta cells (tyrosine phosphatase IA-2)
- Zinc transporter
- Insulin
- If no autoantibodies = idiopathic T1DM
