Diabetes mellitus type 2 screening: Difference between revisions

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* Very high risk or prediabetes (50% within 10 years) -  [http://eurheartjsupp.oxfordjournals.org/content/9/suppl_C/C3/F5.expansion Finnish Diabetes Risk Score] > 20: screen annually
* Very high risk or prediabetes (50% within 10 years) -  [http://eurheartjsupp.oxfordjournals.org/content/9/suppl_C/C3/F5.expansion Finnish Diabetes Risk Score] > 20: screen annually
* High risk (33% within 10 years) -  [http://eurheartjsupp.oxfordjournals.org/content/9/suppl_C/C3/F5.expansion Finnish Diabetes Risk Score] 15 to 20: screen every 3–5 years
* High risk (33% within 10 years) -  [http://eurheartjsupp.oxfordjournals.org/content/9/suppl_C/C3/F5.expansion Finnish Diabetes Risk Score] 15 to 20: screen every 3–5 years
====Postnatal Screening====
=====American College of Obstetricians and Gynecologists=====
It has been estimated that 15-50% of [[gestational diabetes mellitus]]-diagnosed mothers will go on to develop T2DM postpartum.<ref name="pmid16333011">{{cite journal| author=Kaaja RJ, Greer IA| title=Manifestations of chronic disease during pregnancy. | journal=JAMA | year= 2005 | volume= 294 | issue= 21 | pages= 2751-7 | pmid=16333011 | doi=10.1001/jama.294.21.2751 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16333011  }} </ref><ref name="pmid15765129">{{cite journal| author=Buchanan TA, Xiang AH| title=Gestational diabetes mellitus. | journal=J Clin Invest | year= 2005 | volume= 115 | issue= 3 | pages= 485-91 | pmid=15765129 | doi=10.1172/JCI24531 | pmc=PMC1052018 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15765129  }} </ref><ref name="pmid17138780">{{cite journal| author=Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW| title=Rates of postpartum glucose testing after gestational diabetes mellitus. | journal=Obstet Gynecol | year= 2006 | volume= 108 | issue= 6 | pages= 1456-62 | pmid=17138780 | doi=10.1097/01.AOG.0000245446.85868.73 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17138780  }} </ref><ref name="pmid12351492">{{cite journal| author=Kim C, Newton KM, Knopp RH| title=Gestational diabetes and the incidence of type 2 diabetes: a systematic review. | journal=Diabetes Care | year= 2002 | volume= 25 | issue= 10 | pages= 1862-8 | pmid=12351492 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12351492  }} </ref><ref name="pmid20636958">{{cite journal| author=Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E et al.| title=The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study. | journal=Diabet Med | year= 2010 | volume= 27 | issue= 7 | pages= 779-85 | pmid=20636958 | doi=10.1111/j.1464-5491.2010.02995.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20636958  }} </ref> 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<ref name="pmid26696688">{{cite journal| author=American Diabetes Association| title=12. Management of Diabetes in Pregnancy. | journal=Diabetes Care | year= 2016 | volume= 39 Suppl 1 | issue=  | pages= S94-8 | pmid=26696688 | doi=10.2337/dc16-S015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26696688  }} </ref><ref name="pmid17596481">{{cite journal| author=Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR et al.| title=Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. | journal=Diabetes Care | year= 2007 | volume= 30 Suppl 2 | issue=  | pages= S251-60 | pmid=17596481 | doi=10.2337/dc07-s225 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17596481  }} </ref>:
* 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


=== Evidence ===
=== Evidence ===

Revision as of 16:26, 22 April 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]

Screening

Practice Guidelines

U.S. Preventive Services Task Force

Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the U.S. Preventive Services Task Force (USPSTF) concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"[1][2], this was a grade I recommendation when published in 2003. However, the USPSTF does recommend screening for diabetics in adults with hypertension or hyperlipidemia (grade B recommendation).

In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".[3]

Canadian Task Force on Preventive Health Care

The Canadian Task Force on Preventive Health Care recommends the following frequency of screening with glycosylated hemoglobin A based on risk estimated by the Finnish Diabetes Risk Score else Canadian Diabetes Risk Assessment Questionnaire]:[4]

Postnatal Screening

American College of Obstetricians and Gynecologists

It has been estimated that 15-50% of gestational diabetes mellitus-diagnosed mothers will go on to develop T2DM postpartum.[5][6][7][8][9] Consequently, ACOG guidelines currently recommend the following screening methods for T2DM detection:

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[10][11]:

  • 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

Evidence

Accuracy of Tests for Early Detection

If a 2-hour postload glucose level of at least 11.1 mmol/L (≥ 200 mg/dL) is used as the reference standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses current diabetes with[2]:

A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses current diabetes with[12]:

Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not over 7.0%) are predictive of subsequent clinical diabetes in US female health professionals.[13] In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having:

Benefit of Early Detection

Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarbose to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. 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) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event[14].

Other studies have shown that life-style changes[15] and metformin[16] can delay the onset of diabetes.

References

  1. U.S. Preventive Services Task Force (2003). "Screening for type 2 diabetes mellitus in adults: recommendations and rationale". Ann. Intern. Med. 138 (3): 212–4. PMID 12558361. National Guidelines Clearinghouse: Complete Summary
  2. 2.0 2.1 Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN (2003). "Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force". Ann. Intern. Med. 138 (3): 215–29. PMID 12558362.
  3. Santaguida PL, Balion C, Hunt D; et al. (2005). "Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose". Evidence report/technology assessment (Summary) (128): 1–11. PMID 16194123.
  4. Care, Canadian Task Force on Preventive Health (2012-10-16). "Recommendations on screening for type 2 diabetes in adults". Canadian Medical Association Journal. 184 (15): 1687–1696. doi:10.1503/cmaj.120732. ISSN 1488-2329 0820-3946, 1488-2329 Check |issn= value (help). Retrieved 2012-10-17.
  5. 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.
  6. Buchanan TA, Xiang AH (2005). "Gestational diabetes mellitus". J Clin Invest. 115 (3): 485–91. doi:10.1172/JCI24531. PMC 1052018. PMID 15765129.
  7. 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.
  8. 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.
  9. 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.
  10. American Diabetes Association (2016). "12. Management of Diabetes in Pregnancy". Diabetes Care. 39 Suppl 1: S94–8. doi:10.2337/dc16-S015. PMID 26696688.
  11. 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.
  12. Rolka DB, Narayan KM, Thompson TJ; et al. (2001). "Performance of recommended screening tests for undiagnosed diabetes and dysglycemia". Diabetes Care. 24 (11): 1899–903. PMID 11679454.
  13. Pradhan AD, Rifai N, Buring JE, Ridker PM (2007). "Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women". Am. J. Med. 120 (8): 720–7. doi:10.1016/j.amjmed.2007.03.022. PMID 17679132.
  14. 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
  15. 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
  16. 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

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