Classification and Dx of DM: Standards of Care

Question 1

In children, what symptoms of DM1 do most patient’s present with?

Answer 1

polyuria/polydipsia and DKA (approximately 1/3rd)

Question 2

How is DM diagnosed?

Answer 2

Based on either FPG value or 2 h plasma glucose during a 75 g OGTT or A1c criteria (generally all equally appropriate)

Question 3

To avoid misdiagnosis, who should certify A1c tests?

Answer 3

NGSP and standardized to the DCCT assay

Question 4

What is the criteria for the diagnosis of DM?

Answer 4

FPG > 126 mg/dL (no intake for at least 8 hours)
2 h PG > 200 mg/dL during OGTT (75g)
A1c >6.5%
In patient with classic symptoms of hyperglycemia with a random plasma glucose > 200

Unless there is clear clinical diagnosis, diagnosis requires 2 abnormal tst results either from the sampe sample OR in 2 separate samples

Question 5

What may impact the accuracy of the A1c test?

Answer 5

HD, pregnancy, HIV, age, rece/ethnicity, genetic background, and anemia/hemoglobinopathies

Question 6

True or false: A2c, FBG, or 2 h PG can be used to test for pre-DM or DM2 in children?

Answer 6

True

Question 7

In what conditions should A1c not be used to diagnosis DM?

Answer 7

sickle cell disease, pregnancy, glucose 6 phosphate dehydrogenase deficiency, hemolysis, recent blood loss, transfusion or erythropoietin therapy

Only plasma blood glucose should be used do dx DM in these cases

Question 8

Testing for pre-DM and DM should be considered in adults of any age with what?

Answer 8

overweight/obesity or those who have one or more additional risk factors for DM

For all people, testing should begin at age 45. If tests are normal, repeat should be carried out at a minimum of 3 year intervals (sooner with symptoms)

Question 9

What is the diagnostic criteria for pre-DM?

Answer 9

FPG 100-125 mg/d:
2 h PG during 75 g OGTT 140-199 mg/dL
A1c 5.7-6.4%