Diagnosis Flashcards
What is the criteria for diagnosis of diabetes?
Ie; the three parameters and whether the patient is symptomatic or not
FBG > or = 7
A1C > or = 6.5
2 hour gTt > or = 11.1
Random >= 11.1
Repeat of the same test on a different day is needed for diagnosis.
If first test was a random BG however, choose one of the other parameters as test # 2.
UNLESS patient is symptomatic, then only 1 test is needed.
When can an A1C be misleading?
Hemoglobinopathies Iron deficiency Hemolytic anemias Severe hepatic or renal disease. Graves disease Extrme alritude
Altered by ethnicity and aging
Cannot use to dianose in pregnancy or cystic fibrosis or suspicion of type 1
Which ethnicities have a different A1C than Caucasians?
Should you use A1C to diagnose Thea individuals?
Studies of various ethnicities indicate that African Americans, American Indians, Hispanics and Asians have A1C values that are up to 0.4% higher than those of Caucasian patients at similar levels of glycemia. Studies have not been done on similar Canadian ethnicities
***Use alternate diagnosis method. FBG or OGTT
Which lab test parameter is the best prediction for development of macrovascular ie. CV complications?
A1C
For A1C to be used, it must be standardized according to what?
In order to use A1C as a diagnostic criterion, A1C must be measured using a validated assay standardized to the National Glycohemoglobin Standardization Program-Diabetes Control and Complications Trial reference.
DCCT
When can you NOT use A1C to diagnose?
Kids Teens Pregnancy Suspected Type1 Cystic Fibrosis
What 2 diagnostic parameters together can predict 100% progression from pre-diabetes to diabetes?
A1C 6-6.4 plus. FBG 6.1- 6.9
What are the parameters for pre-diabetes diagnosis?
A1c
FBG
2hr PPOGT
A1C 6 - 6.4
FBG 6.1 to 6.9
2 hour PP 75g OGT 7.8 - 11
How is metabolic syndrome diagnosed?
3 or more of: Waist >= 102 men, 88 women (lower for other ethnicities.) TG > or = 1.7 HDL less than 1 (1.3 women) BP > or = 130/85 FBG >= 5.6
WC
ASIAN/central and south America 90/80
EUROPID. MIDDLE EASTERN MEDITERRANEAN AFRICA
94/80
Who should be screened for type 1?
No one. Screening is not cost effective
Who should be screened for type 2?
> = age 40 screen every 3 years OR if high risk using calculator.
More frequent or younger if:
very high risk on risk calc. or risk factors present. Eg. FBG 5.6-6. Or A1C 5.5-5.9 or
1st degree relative
Member of high risk popul
Hx of pre-diabetes
Hx of GD
Hx of macrosomic infant
Presence of micro or macrovascular complications
Vascular risks: abd obesity, overweight, HDL < 1 males <1.3 females, TG > 1.7, smoker, HTN
Presence of assocoated disease (list)
On meds that increase diabetes risk. Eg. Glucocorticoids. Antipsycho, statins, antiretroviral
List risk factors for type 2
9
First degree relative
A’s :Asian (and SEA) Aboriginal African and Hispanic, Arab
Hx of pre-D
Hx of gestational
Hx of macrosomal infant
Diagnosis of macro or micro disease associated with D
Vascular risks: HDL. TG. BP. Abd obeisity, BMI
Associated diseases: schizo. Depression. Bipolar. HIV. Sleep Apnea. PCOS. Acanthosis Nigrans.
Drugs: glucocorticoids. Antipsychotics. HAART. Statins. Thiazides.
When should you do an OGTT in a non pregnant patient?
FBG 6.1-6.9 or A1C 6-6.4
Could do one with FBF 5.6-6 or A1C 5.5-5.9
What 2 recommendations does CDA have to reduce progression of pre to D?
5 % loss of body weight reduces risk progression by 58%.
Drugs: metformin 850mg bid foe 2.8 years. Benefit persists even after washout for more than ten years. 30% resuction.
Acarbose. Reduction risk does not persist once stopped.
Note:liraglutide can reduce progression of IGT to type 2
How are cut off levels determined for diagnosis of diabetes?
The cut offs are the level that predicts the development of retinopathy.
How many Canadians have diabetes (2015)?
How many people with diabetes worldwide?
3.4 million or 9.3% population
300 million diagnosed with another 300 million at risk.
Note: 2009 was 6.8%
