Diabetes: Classifications, Screening Guidelines & Diagnostic Criteria

Question 1

How is Diabetes Mellitus Type I (TIDM) characterized?

Answer 1

• Due to autoimmune beta cell destruction
• Usually leads to absolute insulin deficiency

Question 2

How is Diabetes Mellitus (T2DM) characterized?

Answer 2

• Due to progressive loss of beta cell insulin secretion
• Frequently associated with insulin resistance

Question 3

How is Gestational Diabetes characterized?

Answer 3

• Diagnosed in 2nd or 3rd trimester
  AND
• Not clearly overt diabetes prior to gestation

Question 4

What are the ADA’s DM screening recommendations?

Answer 4

< 45 years old: Screen annually if:
- BMI >/= 25 (or >/= 23 for Asians)
AND
- 1 or more risk factors

> /= 45 years old: Screen every 3 years (if screen is normal)

Question 5

What are the diagnostic criteria for prediabetes?

Answer 5

A1C: 5.7% - 6.4% (repeat unless unequivocal with s/s)

FPG: 100 - 125 mg/dL
(Fasting Plasma Glucose)

OGTT: - 140 - 199 mg/dL
(Oral Glucose Tolerance Test) - mostly used to diagnose gestational DM

Question 6

What are the diagnostic criteria for T2DM?

Answer 6

A1C: >/= 6.5%*

FPG: >/= 126 mg/dL*
(Fasting Plasma Glucose)

OGTT: > 200mg/dL*
(Oral Glucose Tolerance Test) - mostly used to diagnose gestational DM

*Repeat unless unequivocal with s/s

RPG with s/s: > 200 mg/dL X 2
(Random Plasma Glucose)

Question 7

What are the A1C goals per the ADA?

Answer 7

A1C < 6%: pregnant patients

A1C< 6.5%: TIDM (most patients)

A1C < 7%: most adults

A1C < 7.5%: healthy older adults

A1C < 8.0% - 8.5%: older adults with comorbidities (to avoid hypoglycemia)