Diabetes mellitus type 2 screening: Difference between revisions
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* Screening for prediabetes is recommended in patients who are between 40 to 70 years of age and have a BMI in the overweight or obese category (≥ 25). | * Screening for prediabetes is recommended in patients who are between 40 to 70 years of age and have a BMI in the overweight or obese category (≥ 25). | ||
*Persons who have a family history of [[diabetes]], have a history of [[gestational diabetes]] or [[polycystic ovarian syndrome]], or are members of certain racial/ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may be at increased risk for [[diabetes]] at a younger age or at a lower body mass index. Clinicians should consider screening earlier in persons with 1 or more of these characteristics. | *Persons who have a family history of [[diabetes]], have a history of [[gestational diabetes]] or [[polycystic ovarian syndrome]], or are members of certain racial/ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may be at increased risk for [[diabetes]] at a younger age or at a lower body mass index. Clinicians should consider screening earlier in persons with 1 or more of these characteristics. | ||
====Postnatal Screening==== | ====Postnatal Screening==== |
Revision as of 19:24, 21 March 2017
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: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3], Dima Nimri, M.D. [4], Seyedmahdi Pahlavani, M.D. [5]
Overview
Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. American Diabetes Association Recommendations for Diabetes Screening include:
- The general population should be screened every 3 years, beginning at age 45 (especially if their BMI>25kg/m2).
- Younger individuals should be screened if they have BMI>25kg/m2 and at least one of the folling risk factors
- Sedentary life style
- 1st degree relative with DM
- African American, Native American, Latino, Asian American, Pacific Islander
- Low HDL-C
- History of gestational DM
- Polycystic ovary syndrome
- Vascular disease
Screening
Practice Guidelines
U.S. Preventive Services Task Force
According to clinical practice guidelines by the United States Preventive Services Task Force:[1]
- Screening for prediabetes is recommended in patients who are between 40 to 70 years of age and have a BMI in the overweight or obese category (≥ 25).
- Persons who have a family history of diabetes, have a history of gestational diabetes or polycystic ovarian syndrome, or are members of certain racial/ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may be at increased risk for diabetes at a younger age or at a lower body mass index. Clinicians should consider screening earlier in persons with 1 or more of these characteristics.
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.[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
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[9].
Other studies have shown that life-style changes[10] and metformin[11] can delay the onset of diabetes.
References
- ↑ Siu AL, U.S. Preventive Services Task Force (2015). "Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement". Ann Intern Med. 163 (11): 861–8. doi:10.7326/M15-2345. PMID 26501513.
- ↑ 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