Screening for Type 2 Diabetes

MellitusLavina Belayutham

Criteria for Type 2 Diabetes Testing in Asymptomatic Adults

1. Age ≥ 45 years2. Adults with BMI ≥ 25 kg/m2 and have ≥1 of the

following risk factors:a) Physical inactivityb) First- degree relative with diabetesc) Member of high risk race/ ethnicity (African

American, Native American, Asian American, Pacific Islander)

d) Women who delivered a baby weighing > 9lb/4.5kg or were diagnosed with GDM

e) HDL cholesterol level < 35 mg/dl and/or triglyceride level > 250 mg/dl

f) Hypertension (> 140/90 mm Hg) or on therapy g) HbA1C > 5.7%, Impaired Glucose Tolerance (IGT)

or Impaired Fasting Glucose (IFG) on previous testing.

h)Other clinical condition associated with insulin resistance (severe obesity, acanthosis nigricans, PCOS)

i)Cardiovascular disease (CVD history)

3. Normal results, testing repeated in ≥ 3 years intervals or more frequently depending on initial results and risk status.

Screening tests that are used for detection of Diabetes Mellitus

FPG (Fasting Plasma Glucose)

75g 2h Oral Glucose Tolerance Test (OGTT)

RBS (Random Blood Sugar)

HbA1c

Procedure for oral glucose tolerance test (OGTT)

Preparation :1.Not to restrict carbohydrate intake in the days or weeks

before testing.2.Fast overnight for at least 8 hours (water is allowed).3.Remain seated for the duration of the test, and do not

smoke until the test is completed.

Steps :1. A zero time blood sample is drawn. Blood sugar level

measured (fasting plasma glucose).2. The patient is given a glucose solution containing 75g of

glucose to drink within 5 minutes.3. Blood is drawn after 2 hours. Blood sugar level is measured

(2 hour plasma glucose).

WHO recommendations for the diagnostic criteria for diabetes and

intermediate hyperglycemia

Impaired Fasting Glucose

Impaired Glucose Tolerance

Diabetes

Fasting plasma glucose

110-125 mg/dl < 126 mg/dl ≥ 126 mg/dl

2 hour plasma glucose

< 140 mg/dl 140-199 mg/dl ≥ 200 mg/dl

Gestational Diabetes Screening and Diagnosis1.Screen for undiagnosed type 2 diabetes at first prenatal visit in

those with risk factors, using standard diagnostic criteria.2.Screen for GDM at 24-28 weeks of gestation using a 75g-2

hour OGTT.

One-Step Approach: 75g OGTT with plasma glucose measurement. Fasting and at 1

hour and 2 hour Perform OGTT after an overnight fast (≥ 8 hours) Diagnosis of GDM made if plasma glucose values is: Fasting > 92 mg/dl 1hr > 180 mg/dl 2hr > 153 mg/dl

Two-step approach:

• 50 gram glucose load test (nonfasting) at 1 hour, at (24-28 weeks).

• If plasma glucose at 1 hour after load is ≥140 mg/dl, proceed to 100gram OGTT performed while patient is fasting.

• GDM diagnosis made when plasma glucose measurement 3 hour post-test is ≥140 mg/dl.

3.Screen women with GDM for persistent diabetes at 6 to 12 weeks post partum using OGTT and non-pregnancy diagnostic criteria.

4.Women with a history of GDM - lifelong screening every 3 years.

Screening children for Type 2 Diabetes

Criteria :• overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height and any two of the following risk factors: 1. family history of type 2 diabetes in first-or second-degree relative 2.race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander) 3.signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, or PCOS) 4. Maternal history of diabetes or GDM during child’s

gestation

Age of initiation: age 10 years or at onset of puberty

Frequency: every 3 years HbA1C test is recommended for diagnosis in

children and adolescents. Diagnosis : HbA1C ≥6.5% is considered

positive for Diabetes.