Diabetes mellitus type 2 screening
|
Diabetes mellitus type 2 Microchapters |
|
Differentiating Diabetes Mellitus Type 2 from other Diseases |
|
Diagnosis |
|
Treatment |
|
Medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Diabetes screening is recommended for many people at various stages of life, and for those with risk factors. Screening tests are the same tests used for diagnosis. American Diabetes Association recommends screening starting at the age of 45 years in patients with risk factors. Moreover, there are screening strategies for women with history of gestational diabetes, in order to address higher chance of type 2 diabetes development in this specific population. Early diagnosis and treatment can control the complications and result in better clinical outcomes.
Screening
American Diabetes Association
The ADA updated their screening recommendations in 2022[1].
| ADA criteria for testing for diabetes or prediabetes in asymptomatic adults[1] |
|---|
|
2.7 Screening for prediabetes and type 2 diabetes with an informal assessment of risk factors or validated risk calculator should be done in asymptomatic adults. B 2.8 Testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) who have one or more risk factors (Table 2.3). B 2.9 For all people, screening should begin at age 35 years. B 2.10 If tests are normal, repeat screening recommended at a minimum of 3-year intervals is reasonable, sooner with symptoms or change in risk (i.e., weight gain). C 2.11 To screen for prediabetes and type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are each appropriate |
American College of Obstetricians and Gynecologists (ACOG)
It has been estimated that 15-50% of gestational diabetes mellitus-diagnosed mothers will go on to develop T2DM postpartum.[2][3][4][5][6] Consequently, ACOG guidelines currently recommend the following screening methods for T2DM detection:
- 75g 2-hr oral glucose tolerance test (OGTT)
OR
- Fasting plasma glucose at 6-12 weeks postpartum
Fifth International Workshop-Conference on GDM & American Diabetic Association
Data has been presented that estimates only 34% of women with IGT or type 2 diabetes had impaired fasting glucose and that 44% of those with type 2 diabetes had fasting levels 100 mg/day (5.5 mmol/l) during their postpartum visit. Given this risk, it has been suggested by this symposium in conjunction with the ADA that regardless of the 6-12 week screening result, GDM-diagnosed mothers ought to undergo the following screening strategy[7][8]:
- Post-delivery (1–3 days): Fasting or random plasma glucose
- Early postpartum (6-12 weeks postpartum): 75-g 2-h OGTT
- 1 year postpartum: 75-g 2-h OGTT
- Annually: Fasting plasma glucose
- Tri-annually: 75-g 2-h OGTT
- Prepregnancy: 75-g 2-h OGTT
Benefit of Early Detection
- Following the publication of the USPSTF statement, a randomized controlled trial was done and acarbose was prescribed to patients in the "high-risk population" between the ages of 40 and 70 years, whose body mass index (calculated as weight in kilograms divided by the square of height in meters) fell between 25 and 40 kg/m2. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L). The trial revealed a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event[9].
- Other studies have shown that life-style changes[10] and metformin[11] can delay the onset of diabetes.
References
- ↑ 1.0 1.1 American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee:. Draznin B, Aroda VR, Bakris G, Benson G; et al. (2022). "2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022". Diabetes Care. 45 (Supplement_1): S17–S38. doi:10.2337/dc22-S002. PMID 34964875 Check
|pmid=value (help). - ↑ Kaaja RJ, Greer IA (2005). "Manifestations of chronic disease during pregnancy". JAMA. 294 (21): 2751–7. doi:10.1001/jama.294.21.2751. PMID 16333011.
- ↑ Buchanan TA, Xiang AH (2005). "Gestational diabetes mellitus". J Clin Invest. 115 (3): 485–91. doi:10.1172/JCI24531. PMC 1052018. PMID 15765129.
- ↑ Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW (2006). "Rates of postpartum glucose testing after gestational diabetes mellitus". Obstet Gynecol. 108 (6): 1456–62. doi:10.1097/01.AOG.0000245446.85868.73. PMID 17138780.
- ↑ Kim C, Newton KM, Knopp RH (2002). "Gestational diabetes and the incidence of type 2 diabetes: a systematic review". Diabetes Care. 25 (10): 1862–8. PMID 12351492.
- ↑ Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E; et al. (2010). "The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study". Diabet Med. 27 (7): 779–85. doi:10.1111/j.1464-5491.2010.02995.x. PMID 20636958.
- ↑ American Diabetes Association (2016). "12. Management of Diabetes in Pregnancy". Diabetes Care. 39 Suppl 1: S94–8. doi:10.2337/dc16-S015. PMID 26696688.
- ↑ Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR; et al. (2007). "Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus". Diabetes Care. 30 Suppl 2: S251–60. doi:10.2337/dc07-s225. PMID 17596481.
- ↑ Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2003). "Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial". JAMA. 290 (4): 486–94. doi:10.1001/jama.290.4.486. PMID 12876091. ACP Journal Club review
- ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.ACP Journal Club review
- ↑ Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N. Engl. J. Med. 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMID 11832527. ACP Journal Club review